Provider Demographics
NPI:1639850977
Name:HENRY, JASMINE DEIDRE (NP)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:DEIDRE
Last Name:HENRY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:JASMINE
Other - Middle Name:DEIDRE
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:830 GLENWOOD AVE SE STE 510-251
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-1966
Mailing Address - Country:US
Mailing Address - Phone:404-933-2238
Mailing Address - Fax:
Practice Address - Street 1:927 SOCIETY CIR SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-8648
Practice Address - Country:US
Practice Address - Phone:407-924-5326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN191228363L00000X, 363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care