MEDICARE: MR. JEYSOM JOSE KUS FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZC0007X	Surgical Assistant	17-631	WI
2	363LF0000X	Family Nurse Practitioner	F10220503	NV

General Provider Information

NPI Number	:	1124527155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEYSOM JOSE KUS FNP

Provider Business Mailing Address
First Line	:	7155 S RAINBOW BLVD STE 200
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3271
Country	:	US
Telephone Number	:	702-780-6677
Fax Number	:

Provider Business Practice Location Address
First Line	:	7155 S RAINBOW BLVD STE 200
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3271
Country	:	US
Telephone Number	:	702-780-6677
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2018
Last Update Date	:	01/31/2025

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