Healthcare Provider Details

I. General information

NPI: 1467276824
Provider Name (Legal Business Name): JESSICA NICOLE LYNN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26359 HENDERSON RD
MADISON AL
35756-4764
US

IV. Provider business mailing address

26359 HENDERSON RD
MADISON AL
35756-4764
US

V. Phone/Fax

Practice location:
  • Phone: 256-606-4339
  • Fax:
Mailing address:
  • Phone: 256-606-4339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number1-131079
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: