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General NPI Number Information
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NPI Number | 1447716766
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Entity Type | Individual
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Provider Name | JESSICA MENA BLACKWELL PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/11/2019
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Last Update Date | 08/19/2024
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Provider Practice Location Address
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Address Line | 2010 BROOKWOOD MEDICAL CTR DR
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City | BIRMINGHAM
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State | AL
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Zip | 35209-6804
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Country | US
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Telephone | 205-877-1930
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Fax |
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Provider Business Mailing Address
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Address Line | 2320 GRANTLAND PL
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City | HOOVER
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State | AL
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Zip | 35226-1420
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Country | US
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Telephone | 205-396-4008
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1883
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1456
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License Number State | AL
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