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General NPI Number Information
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NPI Number | 1114798428
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Entity Type | Individual
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Provider Name | JENNIFER GRACE PEACOCK RN
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Gender | Female
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Dates
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Enumeration Date | 01/15/2024
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 339 WALKER CHAPEL PLZ STE 115
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City | FULTONDALE
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State | AL
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Zip | 35068-3402
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Country | US
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Telephone | 205-250-6424
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Fax |
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Provider Business Mailing Address
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Address Line | 708 47TH WAY S
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City | BIRMINGHAM
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State | AL
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Zip | 35222-3436
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Country | US
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Telephone | 904-315-1664
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1-190608
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License Number State | AL
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