Healthcare Provider Details

I. General information

NPI: 1881102010
Provider Name (Legal Business Name): JASMINE SHANAE HYPOLITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2018
Last Update Date: 11/26/2021
Certification Date: 11/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LAKE TRAVERSE DR
SISSETON SD
57262
US

IV. Provider business mailing address

777 N AIR DEPOT BLVD APT 4102
OKLAHOMA CITY OK
73110-3765
US

V. Phone/Fax

Practice location:
  • Phone: 605-698-7606
  • Fax: 605-742-0182
Mailing address:
  • Phone: 405-204-4144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCP001525
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number110500
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number110500
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number110500
License Number StateOK
# 5
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCP001525
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: