Healthcare Provider Details

I. General information

NPI: 1508776543
Provider Name (Legal Business Name): JASMINE JENKINS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 OLDE WATERFORD WAY
LELAND NC
28451-4125
US

IV. Provider business mailing address

197 FIELDVIEW TRL SE
WINNABOW NC
28479-5705
US

V. Phone/Fax

Practice location:
  • Phone: 910-641-8640
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2026077226
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: