Active NPI
Latosha Marie Jackson, HAIR STYLIST
- Prosthetist
- Reno, NV
National Provider Identifier
1215631676
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetist
- Practice address
- 3710 Grant Dr Ste a
Reno, NV 89509-5317 - Phone
- (775) 786-0885
- NPI assigned
- Mar 29, 2023
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Prosthetic/Orthotic Supplier | 335E00000X | NV | ||
| Prosthetist | 224P00000X | NV | Primary |
Addresses
Primary practice location
3710 Grant Dr Ste a
Reno, NV 89509-5317
Mailing address
250 Karsten CT
Reno, NV 89506-5630
Phone (775) 770-8023
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Enchanted Essence Beauty Boutique LLC | Prosthetic/Orthotic Supplier | Current | Accepting new patients |
Locations
3710 Grant Dr
Ste A
Reno, NV 89509
Phone (775) 786-0884
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Prosthetic/Orthotic Supplier
- Reno, NV
- NPI 1932897113
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1680048000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1680220800000",
"number": "1215631676",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "250 KARSTEN CT",
"city": "RENO",
"state": "NV",
"postal_code": "895065630",
"telephone_number": "775-770-8023"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3710 GRANT DR STE A",
"city": "RENO",
"state": "NV",
"postal_code": "895095317",
"telephone_number": "775-786-0885"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "LATOSHA",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "HAIR STYLIST",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-03-29",
"last_updated": "2023-03-31",
"certification_date": "2023-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "335E00000X",
"taxonomy_group": "",
"desc": "Prosthetic/Orthotic Supplier",
"state": "NV",
"license": null,
"primary": false
},
{
"code": "224P00000X",
"taxonomy_group": "",
"desc": "Prosthetist",
"state": "NV",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Reno, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.