Provider Demographics
NPI:1225377617
Name:JONES, ANGIE PACHECO
Entity Type:Individual
Prefix:MS
First Name:ANGIE
Middle Name:PACHECO
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ANGELICA
Other - Middle Name:PACHECO
Other - Last Name:GAYATIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:4141 SWENSON ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6718
Mailing Address - Country:US
Mailing Address - Phone:702-595-2844
Mailing Address - Fax:702-445-6853
Practice Address - Street 1:4141 SWENSON ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6718
Practice Address - Country:US
Practice Address - Phone:702-595-2844
Practice Address - Fax:702-796-3152
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN001462363LF0000X
NVRN46490163W00000X
NVAPRN001462363LP2300X, 363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health