Provider Demographics
NPI:1083067037
Name:COTHRON, JENNIFER (NURSE PRACTITONER)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:COTHRON
Suffix:
Gender:F
Credentials:NURSE PRACTITONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3686 GRANDVIEW PKWY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-3407
Mailing Address - Country:US
Mailing Address - Phone:205-802-2000
Mailing Address - Fax:205-776-6155
Practice Address - Street 1:3686 GRANDVIEW PARKWAY
Practice Address - Street 2:SUITE 500
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243
Practice Address - Country:US
Practice Address - Phone:205-802-2000
Practice Address - Fax:205-776-6155
Is Sole Proprietor?:No
Enumeration Date:2016-07-14
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALF0614912363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner