Provider Demographics
NPI:1063194298
Name:PERRY, JESSIE TAYLOR (CRNP)
Entity type:Individual
Prefix:MRS
First Name:JESSIE
Middle Name:TAYLOR
Last Name:PERRY
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 1:701 WINDMILL CIR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:AL
Mailing Address - Zip Code:35080-1130
Mailing Address - Country:US
Mailing Address - Phone:205-587-0847
Mailing Address - Fax:
Practice Address - Street 1:488 SAINT LUKES DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7104
Practice Address - Country:US
Practice Address - Phone:334-288-7808
Practice Address - Fax:334-288-8089
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-162252363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily