Healthcare Provider Details

I. General information

NPI: 1669915666
Provider Name (Legal Business Name): JEHNETTE R LOPEZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2016
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 W HERNDON AVE
CLOVIS CA
93612-0204
US

IV. Provider business mailing address

PO BOX 28949
FRESNO CA
93729-8949
US

V. Phone/Fax

Practice location:
  • Phone: 559-324-6200
  • Fax:
Mailing address:
  • Phone: 559-228-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNPF95005006
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95005006
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: