MEDICARE: JENCY MATHEW

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	845702	NV

General Provider Information

NPI Number	:	1821760307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENCY MATHEW

Provider Business Mailing Address
First Line	:	7021 SPRING MOUNTAIN RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-3818
Country	:	US
Telephone Number	:	702-803-2222
Fax Number	:	702-989-4755

Provider Business Practice Location Address
First Line	:	4810 W ANN RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-1506
Country	:	US
Telephone Number	:	866-389-2727
Fax Number	:

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

Provider Enumeration Date	:	10/02/2021
Last Update Date	:	03/02/2022

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Directions to “ JENCY MATHEW ” Practice Location

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