Healthcare Provider Details

I. General information

NPI: 1750420196
Provider Name (Legal Business Name): JENNIFER GAYLE LOVELL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15024 E LIMESTONE RD STE F
HARVEST AL
35749-7264
US

IV. Provider business mailing address

15024 E LIMESTONE RD STE F
HARVEST AL
35749-7264
US

V. Phone/Fax

Practice location:
  • Phone: 256-262-0535
  • Fax: 256-262-0536
Mailing address:
  • Phone: 562-620-5352
  • Fax: 256-262-0536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1-099417
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number200750044NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: