Provider Demographics
NPI:1700192804
Name:GRAYSON, JASMINE N
Entity Type:Individual
Prefix:MS
First Name:JASMINE
Middle Name:N
Last Name:GRAYSON
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 1:3101 S TAYLOR ST APT 1265
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-6197
Mailing Address - Country:US
Mailing Address - Phone:870-635-0925
Mailing Address - Fax:
Practice Address - Street 1:3101 S TAYLOR ST APT 1265
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-6197
Practice Address - Country:US
Practice Address - Phone:870-635-0925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator