Provider Demographics
NPI:1790669273
Name:LEGGETT, JASMINE JR (LPN)
Entity type:Individual
Prefix:MRS
First Name:JASMINE
Middle Name:
Last Name:LEGGETT
Suffix:JR
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1593 OAKDALE RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-4617
Mailing Address - Country:US
Mailing Address - Phone:607-348-6513
Mailing Address - Fax:
Practice Address - Street 1:1593 OAKDALE RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-4617
Practice Address - Country:US
Practice Address - Phone:607-348-6513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317047164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse