Basic Information
| Provider Information | |||||||||
| NPI: | 1417367582 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONNER | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | |||||||||
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| Credential: | CRNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | STRICKLAND | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
| OtherMiddleName: | CONNER | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 301 BROWN SPRINGS RD | ||||||||
| Address2: | ATTN: PROVIDER ENROLLMENT | ||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361177005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3342734508 | ||||||||
| FaxNumber: | 3342734290 | ||||||||
| Practice Location | |||||||||
| Address1: | 4145 CARMICHAEL RD | ||||||||
| Address2: | |||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361062803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3342737000 | ||||||||
| FaxNumber: | 3342732386 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2014 | ||||||||
| LastUpdateDate: | 01/07/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 1-097110 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.