Provider Demographics
NPI:1255965919
Name:SIZEMORE, JENNIFER ETHEL (MSN, RN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ETHEL
Last Name:SIZEMORE
Suffix:
Gender:
Credentials:MSN, RN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 SOUTHERN OAK DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-7643
Mailing Address - Country:US
Mailing Address - Phone:850-658-2569
Mailing Address - Fax:
Practice Address - Street 1:4296 5TH AVE
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-2173
Practice Address - Country:US
Practice Address - Phone:850-693-4171
Practice Address - Fax:850-693-4171
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-02
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-179211363LP0808X
FLAPRN11008217363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health