MEDICARE: DR. JASMINE CORDIEH TETLEY DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	34745	MS
2	207P00000X	Emergency Medicine Physician	W4213	TX

General Provider Information

NPI Number	:	1881217107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASMINE CORDIEH TETLEY DO

Provider Business Mailing Address
First Line	:	2500 N STATE ST
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39216-4500
Country	:	US
Telephone Number	:	601-984-5882
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 N STATE ST
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39216-4500
Country	:	US
Telephone Number	:	19-845-8826
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2020
Last Update Date	:	05/06/2026

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Directions to “ DR. JASMINE CORDIEH TETLEY DO” Practice Location

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