Active NPI
Jennifer Louise Gough, RDH
- Dental Hygienist
- Birmingham, AL
National Provider Identifier
1609474014
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 8900
- Practice address
- 5720 1St Ave S
Birmingham, AL 35212-2522 - Phone
- (205) 380-9455
- NPI assigned
- Oct 16, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 8900 | AL | Primary |
Addresses
Primary practice location
5720 1St Ave S
Birmingham, AL 35212-2522
Mailing address
113 Knoll Crest Dr
Birmingham, AL 35209-6911
Phone (205) 902-3055
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8900 | AL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1602806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602806400000",
"number": "1609474014",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "113 KNOLL CREST DR",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352096911",
"telephone_number": "205-902-3055"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5720 1ST AVE S",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352122522",
"telephone_number": "205-380-9455"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOUGH",
"first_name": "JENNIFER",
"middle_name": "LOUISE",
"credential": "RDH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-10-16",
"last_updated": "2020-10-16",
"certification_date": "2020-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "AL",
"license": "8900",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Birmingham, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.