Provider Demographics
NPI:1013673607
Name:SCOTT, JASMINE CHERELLE (ED)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:CHERELLE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 EFIRD ST
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-3616
Mailing Address - Country:US
Mailing Address - Phone:980-345-4222
Mailing Address - Fax:
Practice Address - Street 1:2215 US-52, ALBEMARLE, NC 28001
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-2800
Practice Address - Country:US
Practice Address - Phone:980-282-8780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NC1172105174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator