Healthcare Provider Details

I. General information

NPI: 1538918495
Provider Name (Legal Business Name): JASMINE CARTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 CONCERT DR
VIRGINIA BEACH VA
23456-8082
US

IV. Provider business mailing address

1316 ELK CT
VIRGINIA BEACH VA
23464-6367
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-2929
  • Fax:
Mailing address:
  • Phone: 804-432-8359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number0136000923
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: