Healthcare Provider Details

I. General information

NPI: 1073433207
Provider Name (Legal Business Name): JASMINE DIVINITY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 N WALNUT ST
MURFREESBORO TN
37130-2852
US

IV. Provider business mailing address

PO BOX 1091
ANTIOCH TN
37011-1091
US

V. Phone/Fax

Practice location:
  • Phone: 615-437-7191
  • Fax:
Mailing address:
  • Phone: 615-669-0308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: