Healthcare Provider Details

I. General information

NPI: 1730530189
Provider Name (Legal Business Name): KATE LYNN JESSOP APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 08/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 E FLAMINGO RD SUITE E
LAS VEGAS NV
89121-5209
US

IV. Provider business mailing address

2950 E. FLAMINGO ROAD SUITE E.
LAS VEGAS NV
89121-5208
US

V. Phone/Fax

Practice location:
  • Phone: 702-564-6005
  • Fax:
Mailing address:
  • Phone: 702-565-6004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN002214
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: