| Doctor Name: | MR. JEROMY RON MENDENHALL |
| NPI Number: | 1881858280 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA |
| License Number: | |
| Business Practice Address: | 1301 Bertha Howe Ave Suite 1 Mesquite, NV - 890277502 |
| Business Phone Number: | 4356289393 |
| Business Fax Number: | 4356289382 |
| Mailing Address: | 3175 Saint Rose Pkwy 320, HENDERSON |
| State: | NV |
| Postal Code: | 890523508 |
| Phone Number: | 7029979844 |
| Fax Number: | |
| NPI Enumeration Date: | 07/15/2008 |
| NPI Last Update Date: | 10/06/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |