Provider Demographics
NPI:1609525559
Name:PHAM, JESSICA THANH
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:THANH
Last Name:PHAM
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 1:32359 WILDFLOWER TRL
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORT
Mailing Address - State:AL
Mailing Address - Zip Code:36527-8768
Mailing Address - Country:US
Mailing Address - Phone:256-702-7185
Mailing Address - Fax:
Practice Address - Street 1:32359 WILDFLOWER TRL
Practice Address - Street 2:
Practice Address - City:SPANISH FORT
Practice Address - State:AL
Practice Address - Zip Code:36527-8768
Practice Address - Country:US
Practice Address - Phone:256-702-7185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-19
Last Update Date:2022-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program