Healthcare Provider Details

I. General information

NPI: 1972149128
Provider Name (Legal Business Name): JESSICA MILLER HANDLON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA LYNNE MILLER CRNP

II. Dates (important events)

Enumeration Date: 11/22/2019
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4317 DOLLY RIDGE RD STE 201
VESTAVIA AL
35243-5745
US

IV. Provider business mailing address

4200 COLONNADE PKWY
BIRMINGHAM AL
35243-2342
US

V. Phone/Fax

Practice location:
  • Phone: 205-967-9248
  • Fax: 205-967-7125
Mailing address:
  • Phone: 205-971-7613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-169604
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: