Healthcare Provider Details

I. General information

NPI: 1487191441
Provider Name (Legal Business Name): JILL L CUNNINGHAM FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2017
Last Update Date: 01/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 LAKESHORE DR
BIRMINGHAM AL
35229-0001
US

IV. Provider business mailing address

800 LAKESHORE DR
BIRMINGHAM AL
35229-0001
US

V. Phone/Fax

Practice location:
  • Phone: 205-729-2835
  • Fax: 205-726-4042
Mailing address:
  • Phone: 205-729-2835
  • Fax: 205-726-4042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-078491
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: