Healthcare Provider Details

I. General information

NPI: 1891779294
Provider Name (Legal Business Name): MARY PAMELA JENNINGS CRNP, FNP/GNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY PAMELA MILLAN JENNINGS CRNP, FNP/GNP-BC

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PERIMETER PARK S STE 195A
BIRMINGHAM AL
35243-2327
US

IV. Provider business mailing address

PO BOX 211699
EAGAN MN
55121-3699
US

V. Phone/Fax

Practice location:
  • Phone: 866-849-0692
  • Fax: 888-973-8821
Mailing address:
  • Phone: 866-849-0692
  • Fax: 888-973-8821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberTPAN2027
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-080489
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: