Provider Demographics
NPI:1730966524
Name:FOX-BOOKHARDT, JASMINE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JASMINE
Middle Name:
Last Name:FOX-BOOKHARDT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29116-0280
Mailing Address - Country:US
Mailing Address - Phone:843-560-3985
Mailing Address - Fax:
Practice Address - Street 1:8063 EDMUND HWY
Practice Address - Street 2:
Practice Address - City:PELION
Practice Address - State:SC
Practice Address - Zip Code:29123-9805
Practice Address - Country:US
Practice Address - Phone:803-894-3736
Practice Address - Fax:803-894-5315
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5014363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant