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General NPI Number Information
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NPI Number | 1639042328
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Entity Type | Individual
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Provider Name | JANNYLE FRANANDO KEATHLEY MACDULA FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 09/29/2025
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 1321 S RAINBOW BLVD STE 101
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City | LAS VEGAS
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State | NV
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Zip | 89146-9047
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Country | US
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Telephone | 702-508-6186
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Fax |
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Provider Business Mailing Address
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Address Line | 9628 BLUE BELL DR
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City | LAS VEGAS
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State | NV
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Zip | 89134-7831
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Country | US
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Telephone | 707-484-0586
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN56407
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN-CNP894259
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License Number State | NV
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