MEDICARE: JASMINE KING

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	332B00000X	Durable Medical Equipment & Medical Supplies		NC
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1679289219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE KING

Provider Business Mailing Address
First Line	:	7712 N ANCON DR
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-0400
Country	:	US
Telephone Number	:	910-502-3741
Fax Number	:	910-939-6402

Provider Business Practice Location Address
First Line	:	4140 FERNCREEK DR STE 300
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28314-2566
Country	:	US
Telephone Number	:	910-502-3741
Fax Number	:	910-939-6402

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

Provider Enumeration Date	:	01/26/2023
Last Update Date	:	01/23/2026

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Directions to “ JASMINE KING ” Practice Location

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