Provider Demographics
NPI:1194946970
Name:JUSTICE, JENNIFER K (CRNA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:JUSTICE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:J
Other - Last Name:KIRKLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 627
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36831-0627
Mailing Address - Country:US
Mailing Address - Phone:334-528-2499
Mailing Address - Fax:334-528-2499
Practice Address - Street 1:2000 PEPPERELL PKWY
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5452
Practice Address - Country:US
Practice Address - Phone:334-528-2499
Practice Address - Fax:334-528-2497
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-087156163W00000X, 367500000X
GARN144102367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102382 1801867338Medicaid
GA344343OtherWELLCARE CMO - MCCG
AL671345126BMedicaid
AL51591711OtherBCBS
GA671345126AOtherPEACHSTATE CMO - MCCG
GA671345126AMedicaid
GA430080316OtherRAILROAD MCR - MCCG
AL102382 1801867338Medicaid
GA344343OtherWELLCARE CMO - MCCG
AL671345126BMedicaid