Healthcare Provider Details

I. General information

NPI: 1801729355
Provider Name (Legal Business Name): JARED KERRY GREEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 W MESQUITE BLVD STE 113
MESQUITE NV
89027-4774
US

IV. Provider business mailing address

12 W MESQUITE BLVD STE 113
MESQUITE NV
89027-4774
US

V. Phone/Fax

Practice location:
  • Phone: 702-346-4883
  • Fax: 702-664-0426
Mailing address:
  • Phone: 702-346-4883
  • Fax: 702-664-0426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number821483
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number821483
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: