Provider Demographics
NPI:1679086326
Name:RAY, JENNAFER ADAIR (CRNP)
Entity type:Individual
Prefix:MRS
First Name:JENNAFER
Middle Name:ADAIR
Last Name:RAY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:JENNAFER
Other - Middle Name:ADAIR
Other - Last Name:DYKSTRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 11407
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35202-1407
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:817 PRINCETON AVE SW STE 199
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1350
Practice Address - Country:US
Practice Address - Phone:205-780-1920
Practice Address - Fax:205-780-2345
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-164415363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care