Healthcare Provider Details

I. General information

NPI: 1033363189
Provider Name (Legal Business Name): JENNIFER SMITH KIRK CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER KAY SMITH (HATTON) RN

II. Dates (important events)

Enumeration Date: 11/14/2008
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 HAVEN DR
DOTHAN AL
36301-2919
US

IV. Provider business mailing address

207 HAVEN DR
DOTHAN AL
36301-2919
US

V. Phone/Fax

Practice location:
  • Phone: 334-793-3319
  • Fax: 334-793-2291
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-096853
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: