MEDICARE: MR. JANNYLE FRANANDO KEATHLEY MACDULA FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN56407	NV
2	363LF0000X	Family Nurse Practitioner	APRN-CNP894259	NV

General Provider Information

NPI Number	:	1639042328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JANNYLE FRANANDO KEATHLEY MACDULA FNP-BC

Provider Business Mailing Address
First Line	:	9628 BLUE BELL DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-7831
Country	:	US
Telephone Number	:	707-484-0586
Fax Number	:

Provider Business Practice Location Address
First Line	:	1321 S RAINBOW BLVD STE 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-9047
Country	:	US
Telephone Number	:	702-508-6186
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2025
Last Update Date	:	01/06/2026

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