Healthcare Provider Details

I. General information

NPI: 1700741949
Provider Name (Legal Business Name): JESSIKA CHANDREA NETTLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 TAYLOR OAKS CIR UNIT 206
MONTGOMERY AL
36116-8583
US

IV. Provider business mailing address

1301 TAYLOR OAKS CIR UNIT 206
MONTGOMERY AL
36116-8583
US

V. Phone/Fax

Practice location:
  • Phone: 334-590-9733
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-151097
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: