Provider Demographics
NPI:1922354992
Name:WUKASCH, JESSICA (CRNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:WUKASCH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 BROOKWOOD MEDICAL CTR DR STE 402
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6823
Mailing Address - Country:US
Mailing Address - Phone:205-397-9000
Mailing Address - Fax:205-397-9001
Practice Address - Street 1:2006 BROOKWOOD MEDICAL CTR DR STE 402
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-6823
Practice Address - Country:US
Practice Address - Phone:205-397-9000
Practice Address - Fax:205-397-9001
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN196729163W00000X
AL1117405163W00000X, 363L00000X
TX800037163W00000X
CT106377163W00000X
WV98172363LF0000X
TN17946363LF0000X
CT005027363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1533415Medicaid
CT004236346Medicaid