Provider Demographics
NPI:1629891320
Name:RAILTON, JASMINE JENNETTE
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:JENNETTE
Last Name:RAILTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:JENNETTE
Other - Last Name:ERDAIDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA II
Mailing Address - Street 1:10 S CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:PEACHLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28133-8087
Mailing Address - Country:US
Mailing Address - Phone:646-600-1966
Mailing Address - Fax:
Practice Address - Street 1:10 S CLINTON AVE
Practice Address - Street 2:
Practice Address - City:PEACHLAND
Practice Address - State:NC
Practice Address - Zip Code:28133-8087
Practice Address - Country:US
Practice Address - Phone:646-600-1966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-02
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101084376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide