Healthcare Provider Details

I. General information

NPI: 1407775547
Provider Name (Legal Business Name): JASMINE SIMONE GLASS WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SHEPHERD ST
WINSTON SALEM NC
27103-1633
US

IV. Provider business mailing address

3219 PLEASANT GARDEN RD APT 2A
GREENSBORO NC
27406-4641
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-4039
  • Fax:
Mailing address:
  • Phone: 336-567-1293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: