Healthcare Provider Details

I. General information

NPI: 1538707393
Provider Name (Legal Business Name): PATRICK SCOTT JAMESON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2019
Last Update Date: 09/24/2021
Certification Date: 09/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6460 MEDICAL CENTER ST STE 350
LAS VEGAS NV
89148-2423
US

IV. Provider business mailing address

2110 E FLAMINGO RD STE 213
LAS VEGAS NV
89119-5193
US

V. Phone/Fax

Practice location:
  • Phone: 702-255-6647
  • Fax: 702-933-1444
Mailing address:
  • Phone: 702-255-6647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: