Provider Demographics
NPI:1427718022
Name:ROBERSON, JASMINE SHANTE' (APRN)
Entity type:Individual
Prefix:MRS
First Name:JASMINE
Middle Name:SHANTE'
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4302 JOHN WOOD LN
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-9836
Mailing Address - Country:US
Mailing Address - Phone:662-397-7470
Mailing Address - Fax:
Practice Address - Street 1:2245 S LAUDERDALE ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38106-7517
Practice Address - Country:US
Practice Address - Phone:901-948-5558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-22
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30570363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology