Jennifer W Devilleneuve, CRNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

1-097679 Issued in AL

Practice address

4409 Briar Glen Dr
Mountain BRK, AL 35243-1723

Phone

(205) 796-8860

NPI assigned

Mar 28, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/15689/brand/1/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

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  NPD (past)

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

{
    "created_epoch": "1143504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727740800000",
    "number": "1962462374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 CARRAWAY BLVD",
            "address_2": "SUITE 402",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352341913",
            "telephone_number": "205-297-9801",
            "fax_number": "205-297-9804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4409 BRIAR GLEN DR",
            "city": "MOUNTAIN BRK",
            "state": "AL",
            "postal_code": "352431723",
            "telephone_number": "205-796-8860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEVILLENEUVE",
        "first_name": "JENNIFER",
        "middle_name": "W",
        "name_prefix": "Mrs.",
        "credential": "CRNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-03-28",
        "last_updated": "2024-10-01",
        "certification_date": "2024-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "7453518",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AL",
            "license": "1-097679",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "515-28143",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Nurse Practitioner in Mountain BRK, AL
• Providers in Mountain BRK, AL by specialty
• Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2024; 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.