Provider Demographics
NPI:1881858280
Name:MENDENHALL, JEROMY RON (PA)
Entity type:Individual
Prefix:MR
First Name:JEROMY
Middle Name:RON
Last Name:MENDENHALL
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 1:3175 SAINT ROSE PKWY 320
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3508
Mailing Address - Country:US
Mailing Address - Phone:702-997-9844
Mailing Address - Fax:
Practice Address - Street 1:1301 BERTHA HOWE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-7502
Practice Address - Country:US
Practice Address - Phone:435-628-9393
Practice Address - Fax:435-628-9382
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7106674-1206363A00000X, 363AS0400X
NVPA1131363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical