Active NPI
Jessica Park, PHARMD
- Pharmacist
- North Las Vegas, NV
National Provider Identifier
1285010603
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 19063
- Practice address
- 6432 Losee Rd
North Las Vegas, NV 89086-0100 - Phone
- (702) 399-4776
- NPI assigned
- Aug 7, 2015
- Last updated
- Jul 24, 2020
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 19063 | NV | Primary |
Addresses
Primary practice location
6432 Losee Rd
North Las Vegas, NV 89086-0100
Mailing address
6432 Losee Rd
North Las Vegas, NV 89086-0100
Phone (702) 399-4776
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19063 | NV | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nevada CVS Pharmacy LLC | Past | Accepting new patients | |
| Nevada CVS Pharmacy LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1438905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595548800000",
"number": "1285010603",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6432 LOSEE RD",
"city": "NORTH LAS VEGAS",
"state": "NV",
"postal_code": "890860100",
"telephone_number": "702-399-4776"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6432 LOSEE RD",
"city": "NORTH LAS VEGAS",
"state": "NV",
"postal_code": "890860100",
"telephone_number": "702-399-4776"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "JESSICA",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-08-07",
"last_updated": "2020-07-24",
"certification_date": "2020-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NV",
"license": "19063",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.