Active NPI
Matthew Curtis Jackson Jr.
- Adult Companion
- Las Vegas, NV
National Provider Identifier
1558025098
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Companion
- Practice address
- 1155 E Twain Ave Ste 108
Las Vegas, NV 89169-4216 - Phone
- (209) 204-5672
- NPI assigned
- Oct 29, 2021
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Adult Companion | 372600000X | NV | Primary |
Addresses
Primary practice location
1155 E Twain Ave Ste 108
Las Vegas, NV 89169-4216
Mailing address
6170 Boulder Hwy Apt 1006
Las Vegas, NV 89122-7705
Phone (909) 433-0060
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": "1635465600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1635465600000",
"number": "1558025098",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6170 BOULDER HWY APT 1006",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891227705",
"telephone_number": "909-433-0060"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1155 E TWAIN AVE STE 108",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891694216",
"telephone_number": "209-204-5672"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MATTHEW",
"middle_name": "CURTIS",
"name_suffix": "Jr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-10-29",
"last_updated": "2021-10-29",
"certification_date": "2021-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "372600000X",
"taxonomy_group": "",
"desc": "Adult Companion",
"state": "NV",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.