Provider Demographics
NPI:1487025144
Name:NELSON, JASMINE (RSW)
Entity Type:Individual
Prefix:MS
First Name:JASMINE
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:RSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 MARINERS PLAZA DR STE 603
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-6826
Mailing Address - Country:US
Mailing Address - Phone:985-465-4250
Mailing Address - Fax:866-497-7848
Practice Address - Street 1:600 MARINERS PLAZA DR STE 603
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-6826
Practice Address - Country:US
Practice Address - Phone:985-465-4250
Practice Address - Fax:866-497-7848
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13208104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA600723292Medicaid