Provider Demographics
NPI:1336540244
Name:SMART, JASMINE ALICIA (PMHNP)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:ALICIA
Last Name:SMART
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 CAMDEN ST
Mailing Address - Street 2:SUITE 606
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-2012
Mailing Address - Country:US
Mailing Address - Phone:210-229-0688
Mailing Address - Fax:210-229-9890
Practice Address - Street 1:311 CAMDEN ST
Practice Address - Street 2:SUITE 606
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-2012
Practice Address - Country:US
Practice Address - Phone:210-229-0688
Practice Address - Fax:210-229-9890
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX822626163WP0808X
TXAP126225363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health