Individual
JERRY ELLEN OWENSBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
871 CORONADO CENTER DR STE 200, HENDERSON, NV 89052-3977
(702) 803-0034
Mailing address
871 CORONADO CENTER DR STE 200, HENDERSON, NV 89052-3977
(702) 803-0034
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
23843
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1023413
CIGNA PROVIDER NUMBER
AZ
01
—
2Z1452
HEALTHNET PROVIDER NUMBER
AZ
01
—
AZ0838370
BCBS PROVIDER NUMBER
AZ
Enumeration date
07/05/2006
Last updated
06/14/2023
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