Provider Demographics
NPI:1710458419
Name:WALKER, JASMINE GRACE
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:GRACE
Last Name:WALKER
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 1:338 GALVEZ ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39209-3903
Mailing Address - Country:US
Mailing Address - Phone:601-955-9035
Mailing Address - Fax:
Practice Address - Street 1:338 GALVEZ ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39209-3903
Practice Address - Country:US
Practice Address - Phone:601-955-9035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker