Individual provider Active NPI

Jasmine Tatum

  • Prosthetics Case Management
  • Fredericksburg, VA
National Provider Identifier
1104639863
Registry record updated Feb 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetics Case ManagementTaxonomy code 1744P3200X
Practice address
4510 Briarhaven Dr
Fredericksburg, VA 22408-7758
Phone
(240) 988-4324
NPI assigned
Jan 28, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthetics Case Management 1744P3200X Primary

Addresses

Primary practice location

4510 Briarhaven Dr
Fredericksburg, VA 22408-7758

Mailing address

4510 Briarhaven Dr
Fredericksburg, VA 22408-7758
Phone (240) 988-4324

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1738022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738540800000",
    "number": "1104639863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4510 BRIARHAVEN DR",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224087758",
            "telephone_number": "240-988-4324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4510 BRIARHAVEN DR",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224087758",
            "telephone_number": "240-988-4324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TATUM",
        "first_name": "JASMINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-01-28",
        "last_updated": "2025-02-03",
        "certification_date": "2025-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1744P3200X",
            "taxonomy_group": "",
            "desc": "Specialist, Prosthetics Case Management",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fredericksburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.