Provider Demographics
NPI:1669011094
Name:ADAMS, JASMINE (PA-C)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 ROCKY HILL RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-6019
Mailing Address - Country:US
Mailing Address - Phone:615-513-3984
Mailing Address - Fax:
Practice Address - Street 1:4777 ANDREW JACKSON PKWY STE 102
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-1356
Practice Address - Country:US
Practice Address - Phone:615-674-0909
Practice Address - Fax:615-334-0227
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-02
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4195363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program