Provider Demographics
NPI:1124357066
Name:BLEVINS, JENNIFER JANE (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JANE
Last Name:BLEVINS
Suffix:
Gender:F
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 1:6355 S BUFFALO DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2133
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:1302 W CRAIG RD STE A
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-0247
Practice Address - Country:US
Practice Address - Phone:702-473-8380
Practice Address - Fax:702-473-8383
Is Sole Proprietor?:No
Enumeration Date:2009-12-23
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20701363A00000X
NVPA2489363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1124357066Medicaid
NVPA2489OtherSTATE LICENSE