Individual
JESSICA LEIGH FUQUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
6701 AIRPORT BLVD., 'B' BLDG., 'T' LEVEL, MOBILE, AL 36608
(251) 625-6896
Mailing address
29653 ANCHOR BLVD, DAPHNE, AL 36526
(251) 625-6896
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1-100344
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
255792
—
AL
05
—
257688
—
AL
01
—
A10621A
MEDICARE PTAN
AL
01
—
P02566936
RAILROAD MEDICARE
AL
Enumeration date
08/03/2020
Last updated
10/27/2021
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