Provider Demographics
NPI:1265427280
Name:MARTINEZ, JESUS L (ANP)
Entity type:Individual
Prefix:MR
First Name:JESUS
Middle Name:L
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 3467
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:NM
Mailing Address - Zip Code:88021-3467
Mailing Address - Country:US
Mailing Address - Phone:915-886-3088
Mailing Address - Fax:915-866-3022
Practice Address - Street 1:141 VINTON RD
Practice Address - Street 2:E5
Practice Address - City:VINTON
Practice Address - State:TX
Practice Address - Zip Code:79821-8809
Practice Address - Country:US
Practice Address - Phone:915-886-3088
Practice Address - Fax:915-886-3022
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2022-02-16
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-13
Provider Licenses
StateLicense IDTaxonomies
TX241509363LP2300X, 363LW0102X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX005716802Medicaid
TX005716804Medicaid
TXA00002105Medicaid
NM300187628Medicaid
NM000A3665Medicaid
NMA3665Medicaid
TXA00002105Medicaid
TX005716802Medicaid
NM000A3665Medicaid
TXP25200Medicare UPIN