Provider Demographics
NPI:1720017155
Name:STINSON, JENNIFER DENISE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:DENISE
Last Name:STINSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-1980
Mailing Address - Country:US
Mailing Address - Phone:334-793-1881
Mailing Address - Fax:334-712-1815
Practice Address - Street 1:2126 W ROY PARKER RD STE 204
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-8566
Practice Address - Country:US
Practice Address - Phone:334-445-7337
Practice Address - Fax:334-445-0175
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME120872208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009960100Medicaid
AL515-50723OtherBC-BS ALABAMA
AL515-50723OtherBC-BS ALABAMA
AL009960100Medicaid
AL370021468Medicare PIN