Provider Demographics
NPI:1235653742
Name:GATES, JESSICA DANIELLE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:DANIELLE
Last Name:GATES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MOBILE INFIRMARY CIR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-3520
Mailing Address - Country:US
Mailing Address - Phone:251-435-7299
Mailing Address - Fax:
Practice Address - Street 1:3 MOBILE INFIRMARY CIR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3520
Practice Address - Country:US
Practice Address - Phone:251-435-7299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-139445363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily