Provider Demographics
NPI:1326549502
Name:BOTLEY, JASMINE YVONNE (LVN)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:YVONNE
Last Name:BOTLEY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 FANNIN ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-3801
Mailing Address - Country:US
Mailing Address - Phone:409-832-3304
Mailing Address - Fax:
Practice Address - Street 1:8045 FRIAR POINT DR
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-6806
Practice Address - Country:US
Practice Address - Phone:409-433-0315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX333973164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty