MEDICARE: JUDY LESLIE JONES

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	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1770229510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUDY LESLIE JONES

Provider Business Mailing Address
First Line	:	215 QUEST PARK ST APT 518
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-1491
Country	:	US
Telephone Number	:	508-245-6694
Fax Number	:

Provider Business Practice Location Address
First Line	:	2225 E FLAMINGO RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5125
Country	:	US
Telephone Number	:	508-245-6694
Fax Number	:	702-991-7258

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	JUDY LESLIE JONES
Credential	:
Telephone Number	:	508-245-6694

Provider Enumeration Date	:	05/05/2022
Last Update Date	:	05/05/2022

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