Look up the most recent NPI and PECOS records

Jaclyn Rene Gutierrez

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

720 W 34th St # 104, Austin, TX 78705-1205

PECOS Enrollment

This provider is enrolled in PECOS as JACLYN GUTIERREZ.

Based on the most recent information from CMS, provider Jaclyn Rene Gutierrez is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 5 days ago.

Profile Details

Provider ID
1578288189
Provider Type
Individual
Full Name
Gutierrez, Jaclyn Rene
Gender
Female

Sole Proprietor
No
Enumeration Date
10/5/2022
Last Updated
10/5/2022

Contact Information

Practice Location

720 W 34th St # 104, Austin, TX 78705-1205

(512) 261-4800

Unlisted Fax

Mailing Location

2301 S Mopac Expy Apt 837, Austin, TX 78746-7965

(832) 865-7489

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 1095990 Texas

Jaclyn Rene Gutierrez

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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