Provider Demographics
NPI:1891204152
Name:JACOBS, JASMINE KEAMBER (CRNP)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:KEAMBER
Last Name:JACOBS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:KEAMBER
Other - Last Name:MCKINLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 SUN TEMPLE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-8643
Mailing Address - Country:US
Mailing Address - Phone:256-288-3333
Mailing Address - Fax:
Practice Address - Street 1:1615 KATHY LN SW STE 102
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-1026
Practice Address - Country:US
Practice Address - Phone:256-686-4441
Practice Address - Fax:256-686-4443
Is Sole Proprietor?:No
Enumeration Date:2017-09-29
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8033-33363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health