Active NPI
Shanae Jackson
- Social Worker
- Las Vegas, NV
National Provider Identifier
1679140404
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- Practice address
- 4285 N Rancho Dr Ste 160
Las Vegas, NV 89130-3456 - Phone
- (702) 835-1922
- NPI assigned
- Jun 9, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | Primary | ||
| Home Health Aide | 374U00000X | 1306384219 | NV |
Addresses
Primary practice location
4285 N Rancho Dr Ste 160
Las Vegas, NV 89130-3456
Mailing address
3435 W Craig Rd Ste C
North Las Vegas, NV 89032-5116
Other practice location 1
3435 W Craig Rd Ste C
North Las Vegas, NV 89032-5116
Phone (702) 929-3297
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306384219 | Medicaid | NV |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1306384219 | NV | MD | Home Health Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1623196800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1739491200000",
"number": "1679140404",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3435 W CRAIG RD STE C",
"city": "NORTH LAS VEGAS",
"state": "NV",
"postal_code": "890325116"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4285 N RANCHO DR STE 160",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891303456",
"telephone_number": "702-835-1922"
}
],
"practiceLocations": [
{
"address_1": "3435 W Craig Rd Ste C",
"address_purpose": "LOCATION",
"city": "North Las Vegas",
"state": "NV",
"postal_code": "890325116",
"country_code": "US",
"telephone_number": "702-929-3297",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACKSON",
"first_name": "SHANAE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-06-09",
"last_updated": "2025-02-14",
"certification_date": "2025-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": null,
"license": null,
"primary": true
},
{
"code": "374U00000X",
"taxonomy_group": "",
"desc": "Home Health Aide",
"state": "NV",
"license": "1306384219",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1306384219",
"state": "NV"
}
],
"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 Feb 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.