Provider Demographics
NPI:1992277511
Name:RISLEY, JENNA (PA)
Entity type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:
Last Name:RISLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:GOBLIRSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:248 KENT LN
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6539
Mailing Address - Country:US
Mailing Address - Phone:270-300-6674
Mailing Address - Fax:
Practice Address - Street 1:48 MEDICAL PARK DR E STE 350
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3466
Practice Address - Country:US
Practice Address - Phone:270-300-6674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant