Healthcare Provider Details

I. General information

NPI: 1104730761
Provider Name (Legal Business Name): JAZMINE SIMON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3004 JACKSON ST STE C
ALEXANDRIA LA
71301-4745
US

IV. Provider business mailing address

3803 BRIARWOOD BLVD
ALEXANDRIA LA
71303-3302
US

V. Phone/Fax

Practice location:
  • Phone: 318-740-1765
  • Fax:
Mailing address:
  • Phone: 318-740-1765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLA9941
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: