Healthcare Provider Details

I. General information

NPI: 1891139556
Provider Name (Legal Business Name): JAMINE PICKETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2013
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3930 HOWARD HUGHES PKWY STE 300
LAS VEGAS NV
89169-0946
US

IV. Provider business mailing address

3840 N COMMERCE ST STE. 100
NORTH LAS VEGAS NV
89032-8104
US

V. Phone/Fax

Practice location:
  • Phone: 702-560-2192
  • Fax:
Mailing address:
  • Phone: 702-649-5995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: