Basic Information
| Provider Information | |||||||||
| NPI: | 1881102010 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HYPOLITE | ||||||||
| FirstName: | JASMINE | ||||||||
| MiddleName: | SHANAE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 777 N AIR DEPOT BLVD APT 4102 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731103765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052044144 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 LAKE TRAVERSE DR | ||||||||
| Address2: | |||||||||
| City: | SISSETON | ||||||||
| State: | SD | ||||||||
| PostalCode: | 57262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6056987606 | ||||||||
| FaxNumber: | 6057420182 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2018 | ||||||||
| LastUpdateDate: | 11/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | CP001525 | SD | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 163WP2201X | 110500 | OK | N | Nursing Service Providers | Registered Nurse | Ambulatory Care | 363L00000X | 110500 | OK | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LP2300X | 110500 | OK | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 363LP0808X | CP001525 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.