Provider Demographics
NPI:1942071089
Name:FUENTES, JERRY EDWARD (FNP)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:EDWARD
Last Name:FUENTES
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 DAFFODIL AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-6138
Mailing Address - Country:US
Mailing Address - Phone:956-624-2033
Mailing Address - Fax:
Practice Address - Street 1:910 E 8TH ST STE 3
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-4675
Practice Address - Country:US
Practice Address - Phone:956-969-1313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-09
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1146979207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine