Provider Demographics
NPI:1235170259
Name:MONTY, JESSICA AMANDA (CRNP)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:AMANDA
Last Name:MONTY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:AMANDA
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1526 5TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1615
Mailing Address - Country:US
Mailing Address - Phone:205-279-2860
Mailing Address - Fax:205-252-0197
Practice Address - Street 1:1526 5TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1615
Practice Address - Country:US
Practice Address - Phone:205-279-2860
Practice Address - Fax:205-252-0197
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-080516163W00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALQ35754Medicare UPIN