Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 1-146036 | AL |
NPI | 1003305780 |
---|---|
Provider Name | Mrs. Rebecca Jenkins Jones |
First Address | Trussville, AL 35173-1723 |
Second Address | Moody, AL 35004-3014 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2018 |
Last Update Date | 08/05/2018 |