Healthcare Provider Details

I. General information

NPI: 1104636356
Provider Name (Legal Business Name): JENNIFER JOYCE GEDDES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 08/23/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MEDICAL PKWY
CARSON CITY NV
89703-4625
US

IV. Provider business mailing address

PO BOX 19116
RENO NV
89511-0890
US

V. Phone/Fax

Practice location:
  • Phone: 775-845-8000
  • Fax:
Mailing address:
  • Phone: 775-232-4498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: