Healthcare Provider Details

I. General information

NPI: 1386082188
Provider Name (Legal Business Name): JALEESA NAASIA LANKFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6396 MCLEOD DR #9
LAS VEGAS NV
89120-4428
US

IV. Provider business mailing address

98 S MARTIN LUTHER KING BLVD APT. 415
LAS VEGAS NV
89106-4324
US

V. Phone/Fax

Practice location:
  • Phone: 702-912-0600
  • Fax:
Mailing address:
  • Phone: 862-220-7588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: