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General NPI Number Information
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NPI Number | 1093526865
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Entity Type | Individual
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Provider Name | JESSICA RHIANNON IVEY LAC
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Gender | Female
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Dates
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Enumeration Date | 01/20/2025
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Last Update Date | 01/20/2025
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Provider Practice Location Address
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Address Line | 6423 THREE NOTCH RD
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City | MOBILE
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State | AL
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Zip | 36619-1613
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Country | US
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Telephone | 251-510-3113
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Fax |
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Provider Business Mailing Address
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Address Line | 6851 CELTIC DR S
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City | MOBILE
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State | AL
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Zip | 36619-1556
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | U03183
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License Number State | MD
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