Healthcare Provider Details

I. General information

NPI: 1700556289
Provider Name (Legal Business Name): JESSICA YEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 09/16/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 CHRIS DR SW
HUNTSVILLE AL
35802-4189
US

IV. Provider business mailing address

931 FAIRFAX PARK
TUSCALOOSA AL
35406-2805
US

V. Phone/Fax

Practice location:
  • Phone: 256-883-8656
  • Fax:
Mailing address:
  • Phone: 205-343-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-135850
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: