Healthcare Provider Details

I. General information

NPI: 1124932595
Provider Name (Legal Business Name): JENNIFER LYNN DILWORTH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 KIM LN SE
CULLMAN AL
35055-5400
US

IV. Provider business mailing address

1312 KIM LN SE
CULLMAN AL
35055-5400
US

V. Phone/Fax

Practice location:
  • Phone: 256-507-4888
  • Fax:
Mailing address:
  • Phone: 256-507-4888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-192730
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: