Provider Demographics
NPI:1235527672
Name:FORREST, JASMINE MARCHELE
Entity Type:Individual
Prefix:MISS
First Name:JASMINE
Middle Name:MARCHELE
Last Name:FORREST
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:PO BOX 71-0396
Mailing Address - Street 2:7777 S LEWIS AVE. ORU C
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74171
Mailing Address - Country:US
Mailing Address - Phone:404-663-8768
Mailing Address - Fax:
Practice Address - Street 1:7777 S LEWIS AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74171-0003
Practice Address - Country:US
Practice Address - Phone:404-663-8768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator