Healthcare Provider Details

I. General information

NPI: 1295663037
Provider Name (Legal Business Name): JASMINE KENYEL PARKER-MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18993 GAYNON DR
CLINTON TOWNSHIP MI
48035-3952
US

IV. Provider business mailing address

18993 GAYNON DR
CLINTON TOWNSHIP MI
48035-3952
US

V. Phone/Fax

Practice location:
  • Phone: 313-523-7206
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: