Jasmine Nelson-Brock

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

4704409857 Issued in MI

Practice address

20411 W 12 Mile Rd Ste 207
Southfield, MI 48076-6405

Phone

(313) 608-6039

NPI assigned

Dec 19, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Intentional Home Healthcare

  • Home Health Agency
  • Southfield, MI
  • NPI 1013729193
  NPD Authorized official

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

{
    "created_epoch": "1513641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737676800000",
    "number": "1851807440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8081 WYOMING ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482043111",
            "telephone_number": "313-608-6039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20411 W 12 MILE RD STE 207",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480766405",
            "telephone_number": "313-608-6039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON-BROCK",
        "first_name": "JASMINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-19",
        "last_updated": "2025-01-24",
        "certification_date": "2025-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MI",
            "license": "4703114418",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704409857",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Camilla Ndocaj
• Fatoumata Moukir Ndukwe, NP
• Kendall Elizabeth Neary, BEHAVIOR TECHNICIAN
• Anthony Leron Neely, D.D.S.
• Debra Nelms, NP
• Alexis Nelson
• Devonta Travon Nelson
• Isiah Daniel Nelson, LLC
• Jeanette Nelson
• Kim Denise Nelson

• Registered Nurse in Southfield, MI
• Providers in Southfield, MI by specialty
• Registered Nurse in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 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.