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General NPI Number Information
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NPI Number | 1659323541
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Entity Type | Individual
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Provider Name | JESSICA LEIGH PEDERSEN ARNP
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Gender | Female
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 121 N 20TH ST STE 17
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City | OPELIKA
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State | AL
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Zip | 36801-5457
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Country | US
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Telephone | 334-528-6900
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Fax | 334-756-3164
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Provider Business Mailing Address
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Address Line | 325 MAINE ST
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City | LAWRENCE
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State | KS
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Zip | 66044-1360
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Country | US
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Telephone | 785-505-3114
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Fax | 785-505-3113
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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 | 1-178860
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License Number State | AL
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