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NPI Code Detail

MEDICARE: JADEN ALEXIS GONZALES BSN, RN, CCRN

MEDICARE: JADEN ALEXIS GONZALES BSN, RN, CCRN
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
1163W00000XRegistered Nurse1116609TX

General Provider Information

NPI Number : 1588511950
Entity Type Code : Individual
Provider Name (Legal Business Name) : JADEN ALEXIS GONZALES BSN, RN, CCRN
Provider Business Mailing Address
First Line : 2316 80TH ST
Second Line :
City : LUBBOCK
State : TX
Zip : 79423-2324
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 602 INDIANA AVE
Second Line :
City : LUBBOCK
State : TX
Zip : 79415-3364
Country : US
Telephone Number : 806-775-8200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2026
Last Update Date : 03/13/2026

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