Provider Demographics
NPI:1053567354
Name:RICHARDSON, JASMIN JEANETTE (PA)
Entity type:Individual
Prefix:MS
First Name:JASMIN
Middle Name:JEANETTE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1750 CRYSTAL DR
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-3401
Mailing Address - Country:US
Mailing Address - Phone:703-418-1870
Mailing Address - Fax:703-418-2870
Practice Address - Street 1:1750 CRYSTAL DR
Practice Address - Street 2:SUITE 1600
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202-3401
Practice Address - Country:US
Practice Address - Phone:703-418-1870
Practice Address - Fax:703-418-2870
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110003958363A00000X
MDC0003754363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical