Healthcare Provider Details

I. General information

NPI: 1578292710
Provider Name (Legal Business Name): JENNIFER LYNN AVANS CRNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2022
Last Update Date: 06/05/2022
Certification Date: 06/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1963 MEMORIAL PKWY SW STE 5&9
HUNTSVILLE AL
35801-5036
US

IV. Provider business mailing address

16006 DEATON DR SE
HUNTSVILLE AL
35803-2710
US

V. Phone/Fax

Practice location:
  • Phone: 256-536-9300
  • Fax:
Mailing address:
  • Phone: 256-479-1023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-145793
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: