Provider Demographics
NPI:1811697543
Name:CORLEY, JAZMIN (MA)
Entity type:Individual
Prefix:
First Name:JAZMIN
Middle Name:
Last Name:CORLEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10097 BARLOW RD
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:MS
Mailing Address - Zip Code:39083-9565
Mailing Address - Country:US
Mailing Address - Phone:601-341-0292
Mailing Address - Fax:
Practice Address - Street 1:10097 BARLOW RD
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:MS
Practice Address - Zip Code:39083-9565
Practice Address - Country:US
Practice Address - Phone:601-341-0292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2025-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA079849376K00000X
MS74068171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No376K00000XNursing Service Related ProvidersNurse's Aide