MEDICARE: AMBER JEWKES NP

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	363LP0200X	Pediatric Nurse Practitioner	1048629	TX

General Provider Information

NPI Number	:	1902570823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER JEWKES NP

Provider Business Mailing Address
First Line	:	3560 DELAWARE ST STE 1202
Second Line	:
City	:	BEAUMONT
State	:	TX
Zip	:	77706-3061
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3560 DELAWARE ST STE 1202
Second Line	:
City	:	BEAUMONT
State	:	TX
Zip	:	77706-3061
Country	:	US
Telephone Number	:	409-363-5711
Fax Number	:

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

Provider Enumeration Date	:	08/04/2021
Last Update Date	:	08/04/2021

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