Provider Demographics
NPI:1790183416
Name:MAYEUX, JACK J (APRN, FNP)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:J
Last Name:MAYEUX
Suffix:
Gender:M
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 N UNCOMPAHGRE AVE
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-3957
Mailing Address - Country:US
Mailing Address - Phone:970-596-5596
Mailing Address - Fax:970-585-7994
Practice Address - Street 1:33 N UNCOMPAHGRE AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-3957
Practice Address - Country:US
Practice Address - Phone:970-596-5596
Practice Address - Fax:970-585-7994
Is Sole Proprietor?:No
Enumeration Date:2014-12-11
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-APN.0003532-C-APN363LF0000X
LAAP08146363LF0000X
COAPN.0997946-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily