NPI 1689267890 · live from the CMS NPI Registry
Jared Ross Anderson, PA-C
Physician Assistant, Medical in Henderson, NV. National Provider Identifier 1689267890, active.
NPI record
| NPI | 1689267890 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Physician Assistant, Medical 363AM0700X |
| Practice location | 10561 Jeffreys St Ste 230, Henderson, NV 89052 |
| Practice phone | 702-819-8536 |
| Enumerated | February 18, 2021 |
| Last updated | October 10, 2022 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | — |
| Physician Assistant, Medical primary | 363AM0700X | PA2709 (NV) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.