Provider Demographics
NPI:1265100093
Name:MINNIS, JASMINE KINATA (APRN, ACNPC- AG)
Entity type:Individual
Prefix:DR
First Name:JASMINE
Middle Name:KINATA
Last Name:MINNIS
Suffix:
Gender:F
Credentials:APRN, ACNPC- AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9141 MALLARD PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:WALLS
Mailing Address - State:MS
Mailing Address - Zip Code:38680-8003
Mailing Address - Country:US
Mailing Address - Phone:901-907-7676
Mailing Address - Fax:
Practice Address - Street 1:9141 MALLARD PARK BLVD
Practice Address - Street 2:
Practice Address - City:WALLS
Practice Address - State:MS
Practice Address - Zip Code:38680-8003
Practice Address - Country:US
Practice Address - Phone:901-907-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904928363LA2100X
TN29597363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care