Provider Demographics
NPI:1073499422
Name:COLLINS, JASMINE (DSW)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:DSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2214 PERTH CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-4343
Mailing Address - Country:US
Mailing Address - Phone:502-439-4385
Mailing Address - Fax:
Practice Address - Street 1:2214 PERTH CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-4343
Practice Address - Country:US
Practice Address - Phone:502-439-4385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator