Provider Demographics
NPI:1023589454
Name:SHYTLE, JASMINE DIANE MCCORKLE (WHNP)
Entity type:Individual
Prefix:MRS
First Name:JASMINE
Middle Name:DIANE MCCORKLE
Last Name:SHYTLE
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
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Mailing Address - Street 1:475 TRIBBLE GAP RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2478
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3292 PEORIA ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010-1517
Practice Address - Country:US
Practice Address - Phone:303-360-6276
Practice Address - Fax:303-789-7222
Is Sole Proprietor?:No
Enumeration Date:2018-12-11
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN241143163W00000X, 363LW0102X
COC-APN.0002514-C-NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000194320Medicaid