=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093544843
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JALYN JAMMER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2024
-----------------------------------------------------
Last Update Date | 11/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1827 GREENWOOD RD
-----------------------------------------------------
City | PRESCOTT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48756-8626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-873-6200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 845 E KITTLE RD
-----------------------------------------------------
City | MIO
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48647-9746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 4704356052
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------