Provider Demographics
NPI:1548237860
Name:JASMINE, MARY (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:JASMINE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3396 CLOVERLEAF PKWY
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-6992
Mailing Address - Country:US
Mailing Address - Phone:704-403-7740
Mailing Address - Fax:704-403-7750
Practice Address - Street 1:3396 CLOVERLEAF PKWY
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-6992
Practice Address - Country:US
Practice Address - Phone:704-403-7740
Practice Address - Fax:704-403-7750
Is Sole Proprietor?:No
Enumeration Date:2006-03-06
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200418363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7006631Medicaid
NCS83368Medicare UPIN