MEDICARE: JESSE JAMES HARVEY P.A.

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	363A00000X	Physician Assistant	PA2493	NV
2	363AM0700X	Medical Physician Assistant	PA03903	TX

General Provider Information

NPI Number	:	1942209119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSE JAMES HARVEY P.A.

Provider Business Mailing Address
First Line	:	315 N SAN SABA STE 102
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78207-3196
Country	:	US
Telephone Number	:	210-277-1418
Fax Number	:	210-277-1458

Provider Business Practice Location Address
First Line	:	5495 S RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-1871
Country	:	US
Telephone Number	:	725-726-7914
Fax Number	:	210-277-1458

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	05/24/2023

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