Healthcare Provider Details

I. General information

NPI: 1528657624
Provider Name (Legal Business Name): JASMINE HARRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2021
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8721 US HIGHWAY 231
WETUMPKA AL
36092-5342
US

IV. Provider business mailing address

PO BOX 3223
MONTGOMERY AL
36109-0223
US

V. Phone/Fax

Practice location:
  • Phone: 334-279-7830
  • Fax:
Mailing address:
  • Phone: 334-279-7830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: