Healthcare Provider Details

I. General information

NPI: 1629110895
Provider Name (Legal Business Name): JOCELYN A ALLYN FNPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 09/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 MEDICAL CENTER PKWY SUITE 310
SELMA AL
36701-6780
US

IV. Provider business mailing address

PO BOX 1206
SELMA AL
36702-1206
US

V. Phone/Fax

Practice location:
  • Phone: 334-418-6656
  • Fax: 334-418-6657
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number2003027280
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2003027280
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-149809
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: