Healthcare Provider Details

I. General information

NPI: 1740891910
Provider Name (Legal Business Name): JESSICA CELESTE EALEY CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 WATSON BRIDGE RD
KINSEY AL
36303-7629
US

IV. Provider business mailing address

271 WATSON BRIDGE RD
KINSEY AL
36303-7629
US

V. Phone/Fax

Practice location:
  • Phone: 334-618-2550
  • Fax:
Mailing address:
  • Phone: 334-618-2550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: