Provider Demographics
NPI:1336716216
Name:WALKER, JASMINE JETERRA
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:JETERRA
Last Name:WALKER
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 1:7286 SADDLETRAIL CV
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-8685
Mailing Address - Country:US
Mailing Address - Phone:901-282-8625
Mailing Address - Fax:
Practice Address - Street 1:7286 SADDLETRAIL CV
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-8685
Practice Address - Country:US
Practice Address - Phone:901-282-8625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2828625OtherPERSONAL