Provider Demographics
NPI:1639042328
Name:MACDULA, JANNYLE FRANANDO KEATHLEY (FNP-BC)
Entity type:Individual
Prefix:MR
First Name:JANNYLE
Middle Name:FRANANDO KEATHLEY
Last Name:MACDULA
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9628 BLUE BELL DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-7831
Mailing Address - Country:US
Mailing Address - Phone:707-484-0586
Mailing Address - Fax:
Practice Address - Street 1:1321 S RAINBOW BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-9047
Practice Address - Country:US
Practice Address - Phone:702-508-6186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-29
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN56407163W00000X
NVAPRN-CNP894259363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse