Provider Demographics
NPI:1952122855
Name:JACKS, ASHLEIGH MARIE (CRNP)
Entity type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:MARIE
Last Name:JACKS
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 1:408 COUNTY ROAD 20 W
Mailing Address - Street 2:
Mailing Address - City:MARBURY
Mailing Address - State:AL
Mailing Address - Zip Code:36051-2900
Mailing Address - Country:US
Mailing Address - Phone:334-314-9281
Mailing Address - Fax:
Practice Address - Street 1:2105 E SOUTH BLVD
Practice Address - Street 2:MORROW TOWER SUITE 803
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116
Practice Address - Country:US
Practice Address - Phone:334-747-2298
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
AL1-132104363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner