Provider Demographics
NPI:1831827625
Name:DEGRANT, JASAMYN NICHOLS
Entity type:Individual
Prefix:MRS
First Name:JASAMYN
Middle Name:NICHOLS
Last Name:DEGRANT
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 1:203 COLLEGE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2403
Mailing Address - Country:US
Mailing Address - Phone:606-371-2935
Mailing Address - Fax:
Practice Address - Street 1:203 COLLEGE VIEW DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2403
Practice Address - Country:US
Practice Address - Phone:606-371-2935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist