Individual
MRS. JESSIE LEYLA BLACKMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
1940 STONEGATE DR STE 130, VESTAVIA HLS, AL 35242-2541
(205) 977-9876
Mailing address
1940 STONEGATE DR STE 130, VESTAVIA HLS, AL 35242-2541
(205) 977-9876
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1-162172
AL
363LF0000X
Family Nurse Practitioner
Primary
F09201154
AL
Other
Enumeration date
01/09/2019
Last updated
01/22/2022
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