Provider Demographics
NPI:1851681548
Name:BEATTY, JENNIFER JO (CRNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JO
Last Name:BEATTY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:JO
Other - Last Name:HOWARD BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:133 HEATHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-8259
Mailing Address - Country:US
Mailing Address - Phone:256-348-5147
Mailing Address - Fax:256-970-4161
Practice Address - Street 1:133 HEATHERWOOD DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-8259
Practice Address - Country:US
Practice Address - Phone:256-348-5147
Practice Address - Fax:245-970-4161
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-074009 (PENDING)363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care