Jackson Cryses Nightshade

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MI3202 Issued in NV

Practice address

2300 W Sahara Ave Ste 800
Las Vegas, NV 89102-4397

Phone

(702) 545-5854

NPI assigned

Aug 22, 2012

Reactivated

Aug 4, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1345593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691107200000",
    "number": "1255689261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1027 S RAINBOW BLVD PMB 186",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891456232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 W SAHARA AVE STE 800",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891024397",
            "telephone_number": "702-545-5854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIGHTSHADE",
        "first_name": "JACKSON",
        "middle_name": "CRYSES",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-08-22",
        "last_updated": "2023-08-04",
        "certification_date": "2023-08-04",
        "deactivation_date": "2023-01-23",
        "reactivation_date": "2023-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NV",
            "license": "MI3202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erica Nieves
• Michael Nieves
• Victoria Nigbur
• Angela Sue Nighswander, RN, ASN
• Nightingale Home Healthcare of Nevada, Inc
• Nazokat Nigmatova, PHARMD
• Shadi Nijim, M.D.
• Nik Mohamed Nik Mahmood, MSN, APRN, FNP-C
• Asina Nikele
• Jinu Niki, LMFT, LCADC

• Mental Health Counselor in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Mental Health Counselor in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 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.