Jeaniene a Talley MD a Professional

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

10389 Issued in NV

Legal business name

JEANIENE A TALLEY MD A PROFESSIONAL

Practice address

3860 W Ann Rd
N Las Vegas, NV 89031-4409

Phone

(702) 474-4110

NPI assigned

Jan 23, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jeaniene A Talley, MDNPI 1003889585

Title

President

Phone

(702) 474-4110

Specialties & licenses 1

Addresses

Other names 1

• Jateko Family Medical Group Doing business as

Medicare fee-for-service enrollment

Enrolled in NV

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jeaniene Anne Talley, MD

  • Family Medicine Physician
  • N Las Vegas, NV
  • NPI 1003889585
  Medicare reassignment NPD Authorized official
• Emmanuel K Onwutuebe, MD

  • Internal Medicine Physician
  • Las Vegas, NV
  • NPI 1447224431
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1201046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627862400000",
    "number": "1356528103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 92001",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891932001",
            "telephone_number": "702-218-0268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3860 W ANN RD",
            "city": "N LAS VEGAS",
            "state": "NV",
            "postal_code": "890314409",
            "telephone_number": "702-474-4110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEANIENE A TALLEY MD A PROFESSIONAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-23",
        "last_updated": "2021-08-02",
        "certification_date": "2021-08-02",
        "status": "A",
        "authorized_official_last_name": "TALLEY",
        "authorized_official_first_name": "JEANIENE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "702-474-4110",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "10389",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jateko Family Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dorinda James
• Michael Collins James, CRTT
• Tamura M Jamison
• Biljana Janic, M.D.
• Elizabeth Jarman, LCSW
• Jacqueline Danielle Jefferson
• Aaron Christopher Jenkins
• Illyas Malik Jenkins
• Nadia Jenkins
• Traford Montez Jenkins

• Family Medicine Physician in N Las Vegas, NV
• Providers in N Las Vegas, NV by specialty
• Family Medicine Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.