Provider Demographics
NPI:1932981149
Name:JAMES, JODINE KASANDRA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JODINE
Middle Name:KASANDRA
Last Name:JAMES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:JODINE
Other - Middle Name:KASANDRA
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:6005 PARK AVE STE 722B
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5222
Mailing Address - Country:US
Mailing Address - Phone:901-683-8448
Mailing Address - Fax:
Practice Address - Street 1:6005 PARK AVE STE 722B
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5222
Practice Address - Country:US
Practice Address - Phone:901-683-8448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34805363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily