Healthcare Provider Details

I. General information

NPI: 1740769801
Provider Name (Legal Business Name): AMY LEIGH JENKINS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 7TH AVE S BLDG SUIT5604
BIRMINGHAM AL
35233-1711
US

IV. Provider business mailing address

1600 7TH AVE S BLDG SUIT5604
BIRMINGHAM AL
35233-1711
US

V. Phone/Fax

Practice location:
  • Phone: 205-638-9918
  • Fax: 205-638-7455
Mailing address:
  • Phone: 205-638-9918
  • Fax: 205-638-7455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1-114569
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: