MEDICARE: JENNIFER STORY-SALACUP 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	APRN001992	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801263868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER STORY-SALACUP APRN

Provider Business Mailing Address
First Line	:	2110 E FLAMINGO RD STE 105
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5191
Country	:	US
Telephone Number	:	702-695-2084
Fax Number	:	702-537-0981

Provider Business Practice Location Address
First Line	:	2110 E FLAMINGO RD STE 105
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5191
Country	:	US
Telephone Number	:	702-695-2084
Fax Number	:	702-537-0981

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

Provider Enumeration Date	:	08/25/2015
Last Update Date	:	09/25/2025

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