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General NPI Number Information
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NPI Number | 1659615417
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Entity Type | Individual
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Provider Name | JONIE LYNN CHAMPLIN C.R.N.P.
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Gender | Female
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Dates
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Enumeration Date | 11/19/2012
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Last Update Date | 11/19/2012
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Provider Practice Location Address
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Address Line | 273 WINTON M BLOUNT LOOP
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City | MONTGOMERY
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State | AL
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Zip | 36117-3507
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Country | US
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Telephone | 334-280-1527
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Fax | 334-280-1591
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Provider Business Mailing Address
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Address Line | 2343 SANSONE RD
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City | MONTGOMERY
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State | AL
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Zip | 36116-1222
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Country | US
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Telephone | 334-201-1991
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1-117571
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License Number State | AL
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