Provider Demographics
NPI:1073866489
Name:HAMM, JENA WILLIAMS (CRNP)
Entity Type:Individual
Prefix:
First Name:JENA
Middle Name:WILLIAMS
Last Name:HAMM
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JENA
Other - Middle Name:MARIE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13150 HIGHWAY 43
Mailing Address - Street 2:STE 10
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653-4558
Mailing Address - Country:US
Mailing Address - Phone:256-331-2092
Mailing Address - Fax:256-331-2096
Practice Address - Street 1:13150 HIGHWAY 43
Practice Address - Street 2:STE 10
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-4558
Practice Address - Country:US
Practice Address - Phone:256-331-2092
Practice Address - Fax:256-331-2096
Is Sole Proprietor?:No
Enumeration Date:2012-10-23
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-069726363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily