Senior Health Source LLC

Primary specialty

Gerontology Clinical Nurse SpecialistTaxonomy code 364SG0600X

License

1-087343 Issued in AL

Legal business name

SENIOR HEALTH SOURCE LLC

Practice address

27440 County Road 13
Daphne, AL 36526-6222

Phone

(251) 533-6372

NPI assigned

Jun 21, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Karen L Jackson, CRNP

Title

Owner

Phone

(251) 533-6372

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1308614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325203200000",
    "number": "1750677407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7872",
            "city": "SPANISH FORT",
            "state": "AL",
            "postal_code": "365777872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27440 COUNTY ROAD 13",
            "city": "DAPHNE",
            "state": "AL",
            "postal_code": "365266222",
            "telephone_number": "251-533-6372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SENIOR HEALTH SOURCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-21",
        "last_updated": "2011-12-30",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "251-533-6372",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "364SG0600X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Nurse Specialist, Gerontology",
            "state": "AL",
            "license": "1-087343",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Gerontology Clinical Nurse Specialist in Daphne, AL
• Providers in Daphne, AL by specialty
• Gerontology Clinical Nurse Specialist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.