Provider Demographics
NPI:1679967160
Name:WILMES, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WILMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 PELHAM RD N
Mailing Address - Street 2:ATTN: FIELD HOUSE
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-1602
Mailing Address - Country:US
Mailing Address - Phone:256-782-5369
Mailing Address - Fax:256-782-5370
Practice Address - Street 1:700 PELHAM RD N
Practice Address - Street 2:ATTN: FIELD HOUSE
Practice Address - City:JACKSONVILLE
Practice Address - State:AL
Practice Address - Zip Code:36265-1602
Practice Address - Country:US
Practice Address - Phone:256-782-5369
Practice Address - Fax:256-782-5370
Is Sole Proprietor?:No
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer