Breonna Elodia Ginave Jackson

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

LBA0898 Issued in NV

Practice address

7251 W Lake Mead Blvd Ste 300
Las Vegas, NV 89128-8380

Phone

(702) 387-2300

NPI assigned

Oct 31, 2019

Sex

Female

Sole proprietor

No

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mindsprout ABA LLC

  • Behavior Analyst
  • North Las Vegas, NV
  • NPI 1629938667
  NPD Authorized official
• Mindsproutaba LLC

  • Behavior Analyst
  • Sacramento, CA
  • NPI 1528957180
  NPD Authorized official
• Center for Autism & Behavior Analysis, LLC

  • Community/Behavioral Health Agency
  • Las Vegas, NV
  • NPI 1447600143

  Behavior Analyst

  NPD (past)

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

{
    "created_epoch": "1572480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720569600000",
    "number": "1740824937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7251 W LAKE MEAD BLVD STE 300",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891288380",
            "telephone_number": "702-387-2300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7251 W LAKE MEAD BLVD STE 300",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891288380",
            "telephone_number": "702-387-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "BREONNA",
        "middle_name": "ELODIA GINAVE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-31",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NV",
            "license": "LBA0898",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bobbie Jackson
• Brandon Leroy Jackson, P.T.
• Branysha Jackson
• Breiyanna L Jackson, COTA/L
• Brenda Rene Jackson
• Britani Jackson
• Brittaney Jackson
• Brittany Jackson
• Briyona Nicole Jackson, LMT
• Cannell Jackson

• Behavior Analyst in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Behavior Analyst in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2024; 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.