Healthcare Provider Details

I. General information

NPI: 1487444550
Provider Name (Legal Business Name): JESSICA COMPTON CHISENHALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2025
Last Update Date: 05/10/2025
Certification Date: 05/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3690 GRANDVIEW PKWY
BIRMINGHAM AL
35243-3326
US

IV. Provider business mailing address

1932 TREE TOP LN APT A
VESTAVIA HILLS AL
35216-2819
US

V. Phone/Fax

Practice location:
  • Phone: 205-971-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-181946
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: