Provider Demographics
NPI:1033755111
Name:PHILLIPS, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 MOUNTAIN OAKS LN
Mailing Address - Street 2:
Mailing Address - City:WARRIOR
Mailing Address - State:AL
Mailing Address - Zip Code:35180-4700
Mailing Address - Country:US
Mailing Address - Phone:256-338-9972
Mailing Address - Fax:
Practice Address - Street 1:701 PRINCETON AVE SW
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1303
Practice Address - Country:US
Practice Address - Phone:205-780-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-13571163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse