=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235201708
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA DOOLEN NP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 PALO VERDE DR
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89015-6028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-799-0508
-----------------------------------------------------
Fax | 702-700-0510
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6637 SECLUDED AVE
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89110-5155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-453-3757
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LS0200X
-----------------------------------------------------
Taxonomy Name | School Nurse Practitioner
-----------------------------------------------------
License Number | APN000824
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------