Provider Demographics
NPI:1336177856
Name:SHAFTO, JASMINE NOELINE (APRN CNS)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:NOELINE
Last Name:SHAFTO
Suffix:
Gender:F
Credentials:APRN CNS
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:NOELINE
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN CNS
Mailing Address - Street 1:5400 EDALBERT DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:KY
Mailing Address - Zip Code:45239-7695
Mailing Address - Country:US
Mailing Address - Phone:513-741-3100
Mailing Address - Fax:513-741-5686
Practice Address - Street 1:5400 EDALBERT DR.
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:KY
Practice Address - Zip Code:45239-7695
Practice Address - Country:US
Practice Address - Phone:513-741-3100
Practice Address - Fax:513-741-5686
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011307363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100468360Medicaid
KY184607OtherMEDICARE GROUP NUMBER
KY184607OtherMEDICARE GROUP NUMBER