Marsean Jerelle Hardaway, YOUTH INTAKE ADMIN

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

9001 Haviland Rd
Las Vegas, NV 89123-0619

Phone

(702) 462-0067

NPI assigned

Jul 21, 2023

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• 1 Source 211 Services

  • Public Health & General Preventive Medicine Physician
  • Salt Lake City, UT
  • NPI 1407536766
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1689897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689897600000",
    "number": "1245910413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 633",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841100633",
            "telephone_number": "170-246-2006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9001 HAVILAND RD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891230619",
            "telephone_number": "702-462-0067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARDAWAY",
        "first_name": "MARSEAN",
        "middle_name": "JERELLE",
        "name_prefix": "Mr.",
        "credential": "YOUTH INTAKE ADMIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-07-21",
        "last_updated": "2023-07-21",
        "certification_date": "2023-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "146D00000X",
            "taxonomy_group": "",
            "desc": "Personal Emergency Response Attendant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gianina Ramona Harbour
• Martha Harbuck
• Hard Knox LLC
• Amber Jenee Hardaway
• Justice Hardaway
• Megan Taylor Hardcastle, BSN, RN
• Ashley Hardeman
• Stacy Hardeman
• Tasha Nasha Hardeman
• Anthony Harden Jr.

• Student in an Organized Health Care Education/Training Program in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Student in an Organized Health Care Education/Training Program in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.

Verify at the official NPI Registry.