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General NPI Number Information
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NPI Number | 1952122855
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Entity Type | Individual
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Provider Name | ASHLEIGH MARIE JACKS CRNP
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Gender | Female
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Dates
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Enumeration Date | 10/23/2024
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 2105 E SOUTH BLVD MORROW TOWER SUITE 803
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City | MONTGOMERY
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State | AL
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Zip | 36116
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Country | US
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Telephone | 334-747-2298
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Fax |
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Provider Business Mailing Address
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Address Line | 408 COUNTY ROAD 20 W
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City | MARBURY
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State | AL
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Zip | 36051-2900
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Country | US
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Telephone | 334-314-9281
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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 | 1-132104
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License Number State | AL
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