Provider Demographics
NPI:1609253616
Name:SAMSON, JENNIFER (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:SAMSON
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 1:100 CONCOURSE PKWY STE 265
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-2904
Mailing Address - Country:US
Mailing Address - Phone:205-453-4195
Mailing Address - Fax:205-533-7385
Practice Address - Street 1:100 CONCOURSE PKWY STE 265
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-2904
Practice Address - Country:US
Practice Address - Phone:205-453-4195
Practice Address - Fax:205-533-7385
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-122746363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner