Basic Information
| Provider Information | |||||||||
| NPI: | 1467444786 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOUNT | ||||||||
| FirstName: | JERRE | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2091 BOX BUTTE AVENUE | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | ALLIANCE | ||||||||
| State: | NE | ||||||||
| PostalCode: | 693014413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3087627244 | ||||||||
| FaxNumber: | 3087626657 | ||||||||
| Practice Location | |||||||||
| Address1: | 2091 BOX BUTTE AVENUE | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | ALLIANCE | ||||||||
| State: | NE | ||||||||
| PostalCode: | 693014413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3087627244 | ||||||||
| FaxNumber: | 3087626657 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2005 | ||||||||
| LastUpdateDate: | 03/12/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 606 | NE | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.