Provider Demographics
NPI:1164901161
Name:ROMERO, JESUS ALEXIE (ARNP, PMHNP)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:ALEXIE
Last Name:ROMERO
Suffix:
Gender:M
Credentials:ARNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4531 N 16TH ST STE 114
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5344
Mailing Address - Country:US
Mailing Address - Phone:602-266-8700
Mailing Address - Fax:602-296-0404
Practice Address - Street 1:2200 PASEO VERDE PKWY STE 190
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2703
Practice Address - Country:US
Practice Address - Phone:702-589-4871
Practice Address - Fax:702-589-4872
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP11647363LP0808X
NV821846363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty