Provider Demographics
NPI:1114650991
Name:JOHNSON, JASMINE RENEE
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:RENEE
Last Name:JOHNSON
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 1:3230 W BUCKINGHAM RD APT B
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-4341
Mailing Address - Country:US
Mailing Address - Phone:214-646-7098
Mailing Address - Fax:
Practice Address - Street 1:2518 KENESAW DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75212-4537
Practice Address - Country:US
Practice Address - Phone:469-677-0226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion