Healthcare Provider Details

I. General information

NPI: 1225724669
Provider Name (Legal Business Name): JESSICA LUCAS GONZALEZ MSN, CRNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA LUCAS ALTAMIRANO

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15239 AL HIGHWAY 68
CROSSVILLE AL
35962-3481
US

IV. Provider business mailing address

408 MARTLING RD
ALBERTVILLE AL
35951-7208
US

V. Phone/Fax

Practice location:
  • Phone: 256-925-0012
  • Fax: 256-925-0016
Mailing address:
  • Phone: 256-585-5942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-180962
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-180962
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: