Healthcare Provider Details

I. General information

NPI: 1679912190
Provider Name (Legal Business Name): JENNIFER L BYRD CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2013
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 SPRINGHILL MEMORIAL DR N
MOBILE AL
36608-1162
US

IV. Provider business mailing address

3610 SPRINGHILL MEMORIAL DR N
MOBILE AL
36608-1162
US

V. Phone/Fax

Practice location:
  • Phone: 251-410-3600
  • Fax:
Mailing address:
  • Phone: 251-410-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-118405
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-118405
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number1-118405
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: