MEDICARE: JASMINE YVETTE REYES

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	363LF0000X	Family Nurse Practitioner	1088821	TX

General Provider Information

NPI Number	:	1669182051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE YVETTE REYES

Provider Business Mailing Address
First Line	:	13216 BYWELL
Second Line	:
City	:	HORIZON CITY
State	:	TX
Zip	:	79928-2110
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1310 MURCHISON DR STE 100
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-4821
Country	:	US
Telephone Number	:	915-544-4500
Fax Number	:

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

Provider Enumeration Date	:	11/28/2022
Last Update Date	:	11/28/2022

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