Provider Demographics
NPI:1528078912
Name:GDOVIN, JESSICA L (PA-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:GDOVIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:CONTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10624 S EASTERN AVE STE A PMB 873
Mailing Address - Street 2:STE A PMB 873
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-6391
Mailing Address - Country:US
Mailing Address - Phone:702-478-5111
Mailing Address - Fax:702-602-9012
Practice Address - Street 1:3039 W HORIZON RIDGE PKWY STE 110
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4193
Practice Address - Country:US
Practice Address - Phone:702-478-5111
Practice Address - Fax:702-602-9012
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA769363AM0700X, 363AM0700X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVP88214Medicare UPIN
NV37522Medicare ID - Type Unspecified