Healthcare Provider Details

I. General information

NPI: 1316411176
Provider Name (Legal Business Name): JENNIFER LYNNE CORSER-MCNEELY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2019
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 TUSCALOOSA ST
MOBILE AL
36607-3422
US

IV. Provider business mailing address

PO BOX 7987
MOBILE AL
36670-0987
US

V. Phone/Fax

Practice location:
  • Phone: 251-433-3344
  • Fax: 251-433-4052
Mailing address:
  • Phone: 251-633-0573
  • Fax: 251-633-7367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-146784
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: