Active NPI
Keith Darnell Jackson
- Social Worker
- Las Vegas, NV
National Provider Identifier
1033461280
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- Practice address
- 7550 Constantinople Ave
Las Vegas, NV 89129-6505 - Phone
- (702) 349-4042
- NPI assigned
- Oct 12, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | |||
| Social Worker | 104100000X | Primary |
Addresses
Primary practice location
7550 Constantinople Ave
Las Vegas, NV 89129-6505
Mailing address
4790 Pencarrow CT
Las Vegas, NV 89130-2372
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1350000000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350000000000",
"number": "1033461280",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4790 PENCARROW CT",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891302372"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7550 CONSTANTINOPLE AVE",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891296505",
"telephone_number": "702-349-4042"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "KEITH",
"middle_name": "DARNELL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-10-12",
"last_updated": "2012-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.