Provider Demographics
NPI:1124603352
Name:WATERS, JASMINE FAITH (RN)
Entity Type:Individual
Prefix:MRS
First Name:JASMINE
Middle Name:FAITH
Last Name:WATERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13916 CARRINGTON CV
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER
Mailing Address - State:AR
Mailing Address - Zip Code:72002-7308
Mailing Address - Country:US
Mailing Address - Phone:501-407-6377
Mailing Address - Fax:
Practice Address - Street 1:217 W 2ND ST STE 205
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201-2521
Practice Address - Country:US
Practice Address - Phone:501-407-6377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR101487163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse