Provider Demographics
NPI:1841767035
Name:WEBB, JASMINE MACHERYL
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:MACHERYL
Last Name:WEBB
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 1:1146 OAK HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-5571
Mailing Address - Country:US
Mailing Address - Phone:501-672-0456
Mailing Address - Fax:
Practice Address - Street 1:1146 OAK HOLLOW CT
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-5571
Practice Address - Country:US
Practice Address - Phone:501-672-0456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-26
Last Update Date:2024-05-15
Deactivation Date:2022-01-04
Deactivation Code:
Reactivation Date:2024-05-15
Provider Licenses
StateLicense IDTaxonomies
GARN261205363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily