Healthcare Provider Details

I. General information

NPI: 1922395649
Provider Name (Legal Business Name): JENNY KATHLEEN GOBER MCDANIEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8352 W WARM SPRINGS RD STE 200
LAS VEGAS NV
89113-3629
US

IV. Provider business mailing address

8352 W WARM SPRINGS RD STE 200
LAS VEGAS NV
89113-3629
US

V. Phone/Fax

Practice location:
  • Phone: 702-330-0555
  • Fax: 702-832-1128
Mailing address:
  • Phone: 702-330-0555
  • Fax: 702-832-1128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberLL33830
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2017-01884
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number2017-01884
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number26872
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: