Healthcare Provider Details

I. General information

NPI: 1114866407
Provider Name (Legal Business Name): JASMIN DYKES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 CUMBERLAND BLVD SE UNIT 660
ATLANTA GA
30339-4434
US

IV. Provider business mailing address

3205 CUMBERLAND BLVD SE UNIT 660
ATLANTA GA
30339-4434
US

V. Phone/Fax

Practice location:
  • Phone: 504-373-3905
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP284321
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN284321
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: