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General NPI Number Information
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NPI Number | 1164316857
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Entity Type | Individual
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Provider Name | JOSHUA GRANT JACKSON APRN FNP-C
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Gender | Male
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Dates
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Enumeration Date | 06/06/2025
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 5510 S FORT APACHE RD STE 103
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City | LAS VEGAS
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State | NV
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Zip | 89148-7700
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Country | US
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Telephone | 702-899-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 9510 W SAHARA AVE STE 225
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City | LAS VEGAS
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State | NV
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Zip | 89117-8812
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Country | US
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Telephone | 702-843-1353
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 878949
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License Number State | NV
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