Provider Demographics
NPI:1447876339
Name:PARKER, JASMINE LATISHA
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:LATISHA
Last Name:PARKER
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:PO BOX 302
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-0302
Mailing Address - Country:US
Mailing Address - Phone:919-224-6610
Mailing Address - Fax:
Practice Address - Street 1:2179 ELLIOTT ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-6247
Practice Address - Country:US
Practice Address - Phone:919-224-6610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-17
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC5544251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health