Healthcare Provider Details

I. General information

NPI: 1073371233
Provider Name (Legal Business Name): JASMINE BYRD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 HOLLAND RD STE F
MAUMEE OH
43537-1656
US

IV. Provider business mailing address

1655 HOLLAND RD STE F
MAUMEE OH
43537-1656
US

V. Phone/Fax

Practice location:
  • Phone: 833-510-4357
  • Fax: 866-460-2997
Mailing address:
  • Phone: 833-510-4357
  • Fax: 866-460-2997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.193127
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: