Healthcare Provider Details

I. General information

NPI: 1033640925
Provider Name (Legal Business Name): JENNIFER LYNN ANDERSON NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 CLARK ST NE
CULLMAN AL
35055-1953
US

IV. Provider business mailing address

PO BOX 2895
CULLMAN AL
35056-2895
US

V. Phone/Fax

Practice location:
  • Phone: 256-734-3202
  • Fax: 256-734-4668
Mailing address:
  • Phone: 256-735-5044
  • Fax: 256-801-7626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-103722
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: