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General NPI Number Information
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NPI Number | 1700741949
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Entity Type | Individual
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Provider Name | JESSIKA CHANDREA NETTLES
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Gender | Female
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Dates
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Enumeration Date | 12/19/2025
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Last Update Date | 12/19/2025
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Provider Practice Location Address
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Address Line | 1301 TAYLOR OAKS CIR UNIT 206
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City | MONTGOMERY
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State | AL
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Zip | 36116-8583
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Country | US
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Telephone | 334-590-9733
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Fax |
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Provider Business Mailing Address
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Address Line | 1301 TAYLOR OAKS CIR UNIT 206
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City | MONTGOMERY
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State | AL
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Zip | 36116-8583
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Country | US
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Telephone |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1-151097
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License Number State | AL
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