Davita Jackson-Clark, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APRN002570 Issued in NV

Practice address

6600 W Charleston Blvd Ste 111
Las Vegas, NV 89146-1067

Phone

(702) 763-7443

Fax

(702) 763-7443

NPI assigned

Aug 8, 2017

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)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Spring Valley Surgery Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Las Vegas, NV
  • NPI 1154481984
  NPD
• Comprehensive Urgent Care

  • Urgent Care Clinic/Center
  • Las Vegas, NV
  • NPI 1578478673
  NPD (past)
• Foundation for Positively Kids, a Nonprofit Corporation

  • Custodial Care Facility
  • Las Vegas, NV
  • NPI 1962804468
  NPD (past)
• Western State Pain Institute

  • Pain Clinic/Center
  • Las Vegas, NV
  • NPI 1932693447
  NPD (past)

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

{
    "created_epoch": "1502150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703289600000",
    "number": "1871018176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 W CHARLESTON BLVD STE 111",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891461067",
            "telephone_number": "702-763-7443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6600 W CHARLESTON BLVD STE 111",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891461067",
            "telephone_number": "702-763-7443",
            "fax_number": "702-763-7443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON-CLARK",
        "first_name": "DAVITA",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-08",
        "last_updated": "2023-12-23",
        "certification_date": "2023-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NV",
            "license": "APRN002570",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jackson Ophthalmology Group LTD
• Jackson Psychiatric and Primary Care Services
• Lisa Maurine Jackson Smith
• Shaw Jackson Sr
• Symphony Jackson Walker, CNA
• Brianna Jackson-Cook
• Destiny Sharad Jackson-Haley
• Justice Edward Jackson-Haley
• Kimberly Jackson-Hampton, MFT-INTERN
• Anna Jackson-Hill

• Family Nurse Practitioner in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Family Nurse Practitioner in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2023; 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.