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General NPI Number Information
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NPI Number | 1043842909
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Entity Type | Individual
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Provider Name | JEREMY KLEIN
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Gender | Male
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Dates
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Enumeration Date | 02/09/2020
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 590 MITCHELL BLVD BLDG 37547TH
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City | LAUGHLIN AFB
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State | TX
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Zip | 78843-5242
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Country | US
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Telephone | 830-298-6386
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Fax |
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Provider Business Mailing Address
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Address Line | 221 3RD ST W BLDG 1040
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City | JBSA RANDOLPH
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State | TX
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Zip | 78150-4800
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Country | US
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Telephone | 210-652-1951
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | RN60866146
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | AP61176673
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License Number State | WA
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