Individual
JACKIE FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
201 OLD HIGHWAY 25 E, COLUMBIANA, AL 35051-9373
(205) 669-4884
(205) 669-4883
Mailing address
110 INDIAN FOREST TRL, PELHAM, AL 35124-3706
(205) 991-8422
(205) 669-4883
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1-029953
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000060256
—
AL
Enumeration date
03/31/2006
Last updated
05/07/2013
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