Provider Demographics
NPI:1740806991
Name:POWELL, JASMINE
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:POWELL
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 1:59 PEAVINE RD
Mailing Address - Street 2:
Mailing Address - City:BOYLE
Mailing Address - State:MS
Mailing Address - Zip Code:38730-9513
Mailing Address - Country:US
Mailing Address - Phone:662-402-2943
Mailing Address - Fax:
Practice Address - Street 1:4041 KNIGHT ARNOLD RD STE 100
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-2128
Practice Address - Country:US
Practice Address - Phone:901-572-1573
Practice Address - Fax:901-360-0865
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903300363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health