Provider Demographics
NPI:1194073080
Name:JOURNEY, JASMINE NICOLE
Entity type:Individual
Prefix:MRS
First Name:JASMINE
Middle Name:NICOLE
Last Name:JOURNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JASMINE
Other - Middle Name:NICOLE
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2575 FALL RIVER RD
Mailing Address - Street 2:
Mailing Address - City:GOODSPRING
Mailing Address - State:TN
Mailing Address - Zip Code:38460-2206
Mailing Address - Country:US
Mailing Address - Phone:931-638-0824
Mailing Address - Fax:
Practice Address - Street 1:1002 BRINDLEY DR
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-4705
Practice Address - Country:US
Practice Address - Phone:931-363-5438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator