Provider Demographics
NPI:1386298487
Name:MARTIN, JASMINE L (CMS)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:L
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-2538
Mailing Address - Country:US
Mailing Address - Phone:740-442-7044
Mailing Address - Fax:866-475-7263
Practice Address - Street 1:2111 S 7TH ST
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-2538
Practice Address - Country:US
Practice Address - Phone:740-442-7044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-26
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0361717Medicaid