Provider Demographics
NPI:1346022233
Name:NETTLES, JASMINE
Entity Type:Individual
Prefix:MRS
First Name:JASMINE
Middle Name:
Last Name:NETTLES
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 1:5052 MEADOWLAKE CRST
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35020-6074
Mailing Address - Country:US
Mailing Address - Phone:205-705-2411
Mailing Address - Fax:
Practice Address - Street 1:235 INVERNESS CENTER DR
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35242-4805
Practice Address - Country:US
Practice Address - Phone:205-443-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTA7532225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant