Provider Demographics
NPI:1588237036
Name:HOLLEN, JESSE EDMUND
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:EDMUND
Last Name:HOLLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1823 SPRING BROOK CT
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-2587
Mailing Address - Country:US
Mailing Address - Phone:423-723-3192
Mailing Address - Fax:
Practice Address - Street 1:6701 AIRPORT BLVD STE D146
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6701
Practice Address - Country:US
Practice Address - Phone:251-287-2176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty