MEDICARE: KATE LYNN JESSOP APRN

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	363LF0000X	Family Nurse Practitioner	APRN002214	NV

General Provider Information

NPI Number	:	1730530189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATE LYNN JESSOP APRN

Provider Business Mailing Address
First Line	:	2950 E. FLAMINGO ROAD
Second Line	:	SUITE E.
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5208
Country	:	US
Telephone Number	:	702-565-6004
Fax Number	:

Provider Business Practice Location Address
First Line	:	2950 E FLAMINGO RD
Second Line	:	SUITE E
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5209
Country	:	US
Telephone Number	:	702-564-6005
Fax Number	:

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

Provider Enumeration Date	:	06/28/2016
Last Update Date	:	08/12/2016

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