MEDICARE: JASMINE ARIEL MCKNEELY

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
1	172V00000X	Community Health Worker
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1932833241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE ARIEL MCKNEELY

Provider Business Mailing Address
First Line	:	7960 RAFAEL RIVERA WAY UNIT 1493
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-5374
Country	:	US
Telephone Number	:	702-498-7769
Fax Number	:

Provider Business Practice Location Address
First Line	:	7220 S CIMARRON RD STE 210
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-2102
Country	:	US
Telephone Number	:	702-368-2380
Fax Number	:	702-442-7455

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2022
Last Update Date	:	08/04/2022

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Directions to “ JASMINE ARIEL MCKNEELY ” Practice Location

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