Healthcare Provider Details

I. General information

NPI: 1851760284
Provider Name (Legal Business Name): KORTNIE JARDINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2015
Last Update Date: 09/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6396 MCLEOD DR SUITE#6-8
LAS VEGAS NV
89120-4428
US

IV. Provider business mailing address

6012 THORNTON ST
NORTH LAS VEGAS NV
89081-6538
US

V. Phone/Fax

Practice location:
  • Phone: 702-912-0600
  • Fax:
Mailing address:
  • Phone: 702-779-9570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: