Provider Demographics
NPI:1710113196
Name:FLANAGAN, JERMAINE KAREEM (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JERMAINE
Middle Name:KAREEM
Last Name:FLANAGAN
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 1:1111 N TOWN CENTER DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-6364
Mailing Address - Country:US
Mailing Address - Phone:702-562-7105
Mailing Address - Fax:702-562-7318
Practice Address - Street 1:1111 N TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-6364
Practice Address - Country:US
Practice Address - Phone:702-562-7105
Practice Address - Fax:702-562-7318
Is Sole Proprietor?:No
Enumeration Date:2009-05-31
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1160363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical