Provider Demographics
NPI:1477374114
Name:SHORT, JESSICA LIN (CRNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LIN
Last Name:SHORT
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 1:1516 RIVER BEND PL SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-6700
Mailing Address - Country:US
Mailing Address - Phone:229-815-6926
Mailing Address - Fax:
Practice Address - Street 1:1516 RIVER BEND PL SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-6700
Practice Address - Country:US
Practice Address - Phone:229-815-6926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-174915363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner