Healthcare Provider Details

I. General information

NPI: 1235609124
Provider Name (Legal Business Name): JESSICA PEINHARDT RICE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2018
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 CLARK ST NE
CULLMAN AL
35055-1953
US

IV. Provider business mailing address

1900 MAIN AVE SW STE 4
CULLMAN AL
35055-7201
US

V. Phone/Fax

Practice location:
  • Phone: 256-734-3202
  • Fax: 256-734-4668
Mailing address:
  • Phone: 256-734-3759
  • Fax: 256-734-9764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-124853
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: