Healthcare Provider Details

I. General information

NPI: 1740107234
Provider Name (Legal Business Name): JASMINE SAMONE STOWERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2026
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6951 S KENWOOD DR APT 2G
N CHARLESTON SC
29406-4529
US

IV. Provider business mailing address

6951 S KENWOOD DR APT 2G
N CHARLESTON SC
29406-4529
US

V. Phone/Fax

Practice location:
  • Phone: 843-769-1591
  • Fax:
Mailing address:
  • Phone: 843-769-1591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number10102584
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: