Provider Demographics
NPI:1649449018
Name:REID, JENNY JACKSON (CRNP)
Entity type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:JACKSON
Last Name:REID
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 1:364 HONEYSUCKLE RD
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-1140
Mailing Address - Country:US
Mailing Address - Phone:334-794-8656
Mailing Address - Fax:334-671-4957
Practice Address - Street 1:364 HONEYSUCKLE RD
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1140
Practice Address - Country:US
Practice Address - Phone:334-794-8656
Practice Address - Fax:334-671-4957
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-096455363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics