MEDICARE: JAZMINE SHANAE BROWN

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1477362804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAZMINE SHANAE BROWN

Provider Business Mailing Address
First Line	:	1013 SHACKELFORD LN
Second Line	:
City	:	FORNEY
State	:	TX
Zip	:	75126-5096
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1013 SHACKELFORD LN
Second Line	:
City	:	FORNEY
State	:	TX
Zip	:	75126-5096
Country	:	US
Telephone Number	:	945-446-7249
Fax Number	:

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

Provider Enumeration Date	:	12/31/2024
Last Update Date	:	12/31/2024

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Directions to “ JAZMINE SHANAE BROWN ” Practice Location

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