Provider Demographics
NPI:1972129203
Name:ROUX, JENNIFER D (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:D
Last Name:ROUX
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2457 DAKS LODEN CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89044-8767
Mailing Address - Country:US
Mailing Address - Phone:603-448-1941
Mailing Address - Fax:603-448-6059
Practice Address - Street 1:9975 S EASTERN AVE STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-7950
Practice Address - Country:US
Practice Address - Phone:702-659-5604
Practice Address - Fax:702-660-6186
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH075769-23363LF0000X
NV852902363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily