Provider Demographics
NPI:1861741787
Name:VILLEGAS, JEMELY RAMOS (NP)
Entity type:Individual
Prefix:
First Name:JEMELY
Middle Name:RAMOS
Last Name:VILLEGAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 ELLA ST STE A
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4165
Mailing Address - Country:US
Mailing Address - Phone:805-549-9555
Mailing Address - Fax:805-549-0444
Practice Address - Street 1:1304 ELLA ST STE A
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4165
Practice Address - Country:US
Practice Address - Phone:805-549-9555
Practice Address - Fax:805-549-0444
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21957363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF1112152OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS
CAGU257ZOtherMEDICARE PTAN
CA503263OtherREGISTERED NURSE
CA21957OtherNURSE PRACTITIONER LICENSE
CA54018OtherPUBLIC HEALTH NURSING LICENSE