Provider Demographics
NPI:1689136681
Name:RUSSELL, JASTIN (BSN, RN-BC)
Entity Type:Individual
Prefix:MRS
First Name:JASTIN
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:BSN, RN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 LAKE HEATHER RESERVE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-7606
Mailing Address - Country:US
Mailing Address - Phone:256-701-7188
Mailing Address - Fax:
Practice Address - Street 1:12100 COUNTY LINE RD STE A2
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35756-2006
Practice Address - Country:US
Practice Address - Phone:256-724-7714
Practice Address - Fax:256-724-7065
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-157898163W00000X, 163WG0100X, 163WM0705X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WG0100XNursing Service ProvidersRegistered NurseGastroenterology
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical