MEDICARE: MRS. JASMINE SHERNISE WIGGINS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1477308674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JASMINE SHERNISE WIGGINS

Provider Business Mailing Address
First Line	:	1700 11TH AVE
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31707-3451
Country	:	US
Telephone Number	:	229-255-5684
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 11TH AVE
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31707-3451
Country	:	US
Telephone Number	:	229-255-5684
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2024
Last Update Date	:	04/22/2024

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