Active NPI
Deonte Ray Jackson
- Rehabilitation Practitioner
- Henderson, NV
National Provider Identifier
1285984096
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Practitioner
- Practice address
- 1385 European Dr
Henderson, NV 89052-4021 - Phone
- (702) 738-0206
- NPI assigned
- Sep 19, 2012
- Sex
- Male
- Sole proprietor
- Yes
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 | Primary |
Addresses
Primary practice location
1385 European Dr
Henderson, NV 89052-4021
Mailing address
1385 European Dr
Henderson, NV 89052-4021
Phone (702) 738-0206
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348012800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1348012800000",
"number": "1285984096",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1385 EUROPEAN DR",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890524021",
"telephone_number": "702-738-0206"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1385 EUROPEAN DR",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890524021",
"telephone_number": "702-738-0206"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "DEONTE",
"middle_name": "RAY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-09-19",
"last_updated": "2012-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Henderson, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.