Provider Demographics
NPI:1619484797
Name:MAYER, JENNIFER BARBA (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BARBA
Last Name:MAYER
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 1:12020 SOUTHERN HIGHLANDS PKWY
Mailing Address - Street 2:1103
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141
Mailing Address - Country:US
Mailing Address - Phone:210-867-2833
Mailing Address - Fax:
Practice Address - Street 1:2210 E CALVADA BLVD
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-5804
Practice Address - Country:US
Practice Address - Phone:775-727-6400
Practice Address - Fax:775-751-6592
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-10
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA11995363A00000X
NVPA0393207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant