Provider Demographics
NPI:1902342983
Name:SHULTZ, JEREMY ALLEN (CRNP)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:ALLEN
Last Name:SHULTZ
Suffix:
Gender:M
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:PO BOX 11407
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-8124
Mailing Address - Country:US
Mailing Address - Phone:256-894-6635
Mailing Address - Fax:256-894-6808
Practice Address - Street 1:2505 US HIGHWAY 431
Practice Address - Street 2:
Practice Address - City:BOAZ
Practice Address - State:AL
Practice Address - Zip Code:35957-5908
Practice Address - Country:US
Practice Address - Phone:256-894-6800
Practice Address - Fax:256-894-6808
Is Sole Proprietor?:No
Enumeration Date:2017-01-13
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-135341363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care