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General NPI Number Information
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NPI Number | 1790183416
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Entity Type | Individual
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Provider Name | JACK J. MAYEUX APRN, FNP
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Gender | Male
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Dates
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Enumeration Date | 12/11/2014
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Last Update Date | 05/24/2023
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Provider Practice Location Address
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Address Line | 33 N UNCOMPAHGRE AVE
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City | MONTROSE
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State | CO
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Zip | 81401-3957
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Country | US
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Telephone | 970-596-5596
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Fax | 970-585-7994
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Provider Business Mailing Address
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Address Line | 33 N UNCOMPAHGRE AVE
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City | MONTROSE
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State | CO
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Zip | 81401-3957
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Country | US
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Telephone | 970-596-5596
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Fax | 970-585-7994
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | C-APN.0003532-C-APN
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License Number State | CO
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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 | AP08146
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN.0997946-NP
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License Number State | CO
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