Healthcare Provider Details

I. General information

NPI: 1295572923
Provider Name (Legal Business Name): JAYISON MCCORKLE II NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2370 CORPORATE CIR STE 230
HENDERSON NV
89074-7752
US

IV. Provider business mailing address

1293 OSSA ST
HENDERSON NV
89052-8774
US

V. Phone/Fax

Practice location:
  • Phone: 725-235-7884
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number845967
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: