Provider Demographics
NPI:1629709910
Name:JOHNSON, JASMIN MICHELLE
Entity Type:Individual
Prefix:
First Name:JASMIN
Middle Name:MICHELLE
Last Name:JOHNSON
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 1:2627 DOUGLAS AVE APT 222
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-6021
Mailing Address - Country:US
Mailing Address - Phone:972-684-4043
Mailing Address - Fax:
Practice Address - Street 1:2627 DOUGLAS AVE APT 222
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-6021
Practice Address - Country:US
Practice Address - Phone:972-684-4043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-18
Last Update Date:2022-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No171400000XOther Service ProvidersHealth & Wellness Coach