Individual
JESSICA MENA BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2010 BROOKWOOD MEDICAL CTR DR, BIRMINGHAM, AL 35209-6804
(205) 877-1930
Mailing address
2320 GRANTLAND PL, HOOVER, AL 35226-1420
(205) 396-4008
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1456
AL
363AM0700X
Medical Physician Assistant
1883
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336101401
—
AL
Enumeration date
02/11/2019
Last updated
08/19/2024
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