Healthcare Provider Details

I. General information

NPI: 1063096550
Provider Name (Legal Business Name): MR. JEREMY C ALEXANDER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MR. JEREMY ALEXANDER III

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 E HORIZON RIDGE PKWY STE 110-428
HENDERSON NV
89002-7905
US

IV. Provider business mailing address

35 E HORIZON RIDGE PKWY STE 110-428
HENDERSON NV
89002-7905
US

V. Phone/Fax

Practice location:
  • Phone: 702-305-8810
  • Fax:
Mailing address:
  • Phone: 702-305-8810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: