Provider Demographics
NPI:1053686311
Name:STURGILL, JEREMEY DWAYNE (PA-C)
Entity Type:Individual
Prefix:
First Name:JEREMEY
Middle Name:DWAYNE
Last Name:STURGILL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3325 RESEARCH WAY
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-7913
Mailing Address - Country:US
Mailing Address - Phone:775-888-6610
Mailing Address - Fax:
Practice Address - Street 1:3900 CAMBRIDGE ST STE 102
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-7440
Practice Address - Country:US
Practice Address - Phone:702-307-5415
Practice Address - Fax:702-307-5416
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA2495363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVPA2495OtherNV PA LICENSE