Provider Demographics
NPI:1316411176
Name:CORSER-MCNEELY, JENNIFER LYNNE
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNNE
Last Name:CORSER-MCNEELY
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:PO BOX 7987
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36670-0987
Mailing Address - Country:US
Mailing Address - Phone:251-633-0573
Mailing Address - Fax:251-633-7367
Practice Address - Street 1:141 TUSCALOOSA ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3422
Practice Address - Country:US
Practice Address - Phone:251-433-3344
Practice Address - Fax:251-433-4052
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-146784363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL230306Medicaid
ALP02224926OtherRR MEDICARE
AL230307Medicaid
AL512-22345OtherBCBS OF AL
AL512-22344OtherBCBS OF AL
AL512-22346OtherBCBS OF AL
AL229638Medicaid
AL512-22342OtherBCBS OF AL
AL6352151OtherAETNA
ALZ93605OtherVIVA HEALTH
AL512-22343OtherBCBS OF AL
AL228477Medicaid
AL229592Medicaid
ALA05462AOtherMEDICARE
MS01201008Medicaid