Healthcare Provider Details

I. General information

NPI: 1740159789
Provider Name (Legal Business Name): JASMAINE NIKIA PARKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2025
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E PRATT ST
BALTIMORE MD
21202-3116
US

IV. Provider business mailing address

3810 NEMO RD
RANDALLSTOWN MD
21133-4155
US

V. Phone/Fax

Practice location:
  • Phone: 443-543-9980
  • Fax:
Mailing address:
  • Phone: 443-487-1270
  • Fax: 443-487-1270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: