Healthcare Provider Details

I. General information

NPI: 1417870916
Provider Name (Legal Business Name): JEWERS MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

59 DAMONTE RANCH PKWY STE B403
RENO NV
89521-1907
US

IV. Provider business mailing address

59 DAMONTE RANCH PKWY STE B403
RENO NV
89521-1907
US

V. Phone/Fax

Practice location:
  • Phone: 617-223-1579
  • Fax:
Mailing address:
  • Phone: 617-223-1579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: BRIAN JEWERS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: PMHNP
Phone: 617-223-1579