Healthcare Provider Details

I. General information

NPI: 1982442075
Provider Name (Legal Business Name): JON PENN JUNEJO DNP, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 N TOWN CENTER DR STE 100
LAS VEGAS NV
89144-6308
US

IV. Provider business mailing address

1180 N TOWN CENTER DR STE 100
LAS VEGAS NV
89144-6308
US

V. Phone/Fax

Practice location:
  • Phone: 725-900-4866
  • Fax: 702-560-3101
Mailing address:
  • Phone: 725-900-4866
  • Fax: 702-560-3101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP.AP.61581110-NP
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number886891
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: