Provider Demographics
NPI:1740597905
Name:SMALLEY, JESSICA K (CRNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:K
Last Name:SMALLEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:K
Other - Last Name:DOCKERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:922 FAIRFAX PARK
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2804
Mailing Address - Country:US
Mailing Address - Phone:205-391-9300
Mailing Address - Fax:205-391-9374
Practice Address - Street 1:922 FAIRFAX PARK
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2804
Practice Address - Country:US
Practice Address - Phone:205-391-9300
Practice Address - Fax:205-391-9374
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-115082363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily