MEDICARE: JESICA MAE TEJADA BULAY PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	866479	NV

General Provider Information

NPI Number	:	1730019191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESICA MAE TEJADA BULAY PMHNP

Provider Business Mailing Address
First Line	:	9317 GRAND GATE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89143-2300
Country	:	US
Telephone Number	:	929-461-1766
Fax Number	:

Provider Business Practice Location Address
First Line	:	9317 GRAND GATE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89143-2300
Country	:	US
Telephone Number	:	929-461-1766
Fax Number	:

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

Provider Enumeration Date	:	05/19/2026
Last Update Date	:	05/19/2026

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