Provider Demographics
NPI:1952821936
Name:KIRKLAND, JASMINE DARNIECE (FNP)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:DARNIECE
Last Name:KIRKLAND
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 PROFESSIONAL PKWY STE 2020
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-5632
Mailing Address - Country:US
Mailing Address - Phone:470-956-1570
Mailing Address - Fax:
Practice Address - Street 1:6001 PROFESSIONAL PKWY STE 2020
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-5632
Practice Address - Country:US
Practice Address - Phone:470-956-1570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23045163W00000X
TXAP133880363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0035TDOtherBLUE CROSS BLUE SHIELD OF TEXAS GRP REC #
TX153449704Medicaid