1568618262 NPI number — MRS. JENNIFER L MCNEASE CRNP

Table of content: MRS. JENNIFER L MCNEASE CRNP (NPI 1568618262)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568618262 NPI number — MRS. JENNIFER L MCNEASE CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCNEASE
Provider First Name:
JENNIFER
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568618262
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 465
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILLRY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36558-0465
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-846-3233
Provider Business Mailing Address Fax Number:
251-846-3224

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
73 LONG STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILLRY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-846-3233
Provider Business Practice Location Address Fax Number:
251-846-3224
Provider Enumeration Date:
08/13/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  1-096789 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 008450553 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 137616 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03521065 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 137329 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51593390 . This is a "BCBS - 1707 CENTER ST" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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