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NPI Code Detail

MEDICARE: KELLY ROBIN JACKSON-KING MD

MEDICARE: KELLY ROBIN JACKSON-KING MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology Physician9540NV
2207V00000XObstetrics & Gynecology PhysicianME125609FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1497726806
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY ROBIN JACKSON-KING MD
Provider Business Mailing Address
First Line : 3196 S MARYLAND PKWY
Second Line :
City : LAS VEGAS
State : NV
Zip : 89109-2305
Country : US
Telephone Number : 702-255-3547
Fax Number :
Provider Business Practice Location Address
First Line : 3196 S MARYLAND PKWY
Second Line :
City : LAS VEGAS
State : NV
Zip : 89109-2305
Country : US
Telephone Number : 702-255-3547
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2006
Last Update Date : 11/04/2015

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