Provider Demographics
NPI:1992391627
Name:BRETT, JEREMY J (PA)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:J
Last Name:BRETT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 WATERTON LAKES AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-2809
Mailing Address - Country:US
Mailing Address - Phone:385-201-6862
Mailing Address - Fax:
Practice Address - Street 1:6460 MEDICAL CENTER ST UNIT 200350
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-2406
Practice Address - Country:US
Practice Address - Phone:702-255-6647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA2431363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant