Active NPI
Endeeia Shree Jackson
- Rehabilitation Practitioner
- Las Vegas, NV
National Provider Identifier
1154842334
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Practitioner
- License
- 1601744335
- Practice address
- 5370 E Craig Rd Apt 2223
Las Vegas, NV 89115-2179 - Phone
- (702) 771-0091
- NPI assigned
- Jun 28, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Practitioner | 225400000X | 1601744335 | NV | Primary |
Addresses
Primary practice location
5370 E Craig Rd Apt 2223
Las Vegas, NV 89115-2179
Mailing address
3097 E Warm Springs Rd Ste 400
Las Vegas, NV 89120-3757
Phone (702) 850-8700
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1601744335 | NV | MD | Rehabilitation Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498608000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1498608000000",
"number": "1154842334",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3097 E WARM SPRINGS RD STE 400",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891203757",
"telephone_number": "702-850-8700",
"fax_number": "702-850-8707"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5370 E CRAIG RD APT 2223",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891152179",
"telephone_number": "702-771-0091"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "ENDEEIA",
"middle_name": "SHREE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-06-28",
"last_updated": "2017-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": "NV",
"license": "1601744335",
"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 Jun 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.