Individual
JESSICA BACON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1802 6TH AVE S, BIRMINGHAM, AL 35233-1932
(205) 902-8865
Mailing address
340 WOODLAND TRL, PELL CITY, AL 35125-0329
(205) 902-8865
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
1-174970
AL
Other
Enumeration date
09/13/2021
Last updated
09/13/2021
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