=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942209119
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSE JAMES HARVEY P.A.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2005
-----------------------------------------------------
Last Update Date | 05/24/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5495 S RAINBOW BLVD
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89118-1871
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 725-726-7914
-----------------------------------------------------
Fax | 210-277-1458
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 315 N SAN SABA STE 102
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78207-3196
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-277-1418
-----------------------------------------------------
Fax | 210-277-1458
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA2493
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | PA03903
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------