Provider Demographics
NPI:1801261771
Name:SHOEMAKE, JENNIFER DELL (PPCNP-BC, CRNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DELL
Last Name:SHOEMAKE
Suffix:
Gender:F
Credentials:PPCNP-BC, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42D MEDICAL GROUP
Mailing Address - Street 2:300 SOUTH TWINING ST, BLDG 760
Mailing Address - City:MAXWELL
Mailing Address - State:AL
Mailing Address - Zip Code:36112-6027
Mailing Address - Country:US
Mailing Address - Phone:334-953-5200
Mailing Address - Fax:334-953-8607
Practice Address - Street 1:42D MEDICAL GROUP
Practice Address - Street 2:300 S. TWINING ST. BLDG 760
Practice Address - City:MAXWELL AFB
Practice Address - State:AL
Practice Address - Zip Code:36112-6027
Practice Address - Country:US
Practice Address - Phone:334-953-5143
Practice Address - Fax:334-953-8607
Is Sole Proprietor?:No
Enumeration Date:2015-12-03
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015753363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics