MEDICARE: KEITH DARNELL JACKSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst
2	104100000X	Social Worker

General Provider Information

NPI Number	:	1033461280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH DARNELL JACKSON

Provider Business Mailing Address
First Line	:	4790 PENCARROW CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-2372
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7550 CONSTANTINOPLE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6505
Country	:	US
Telephone Number	:	702-349-4042
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2012
Last Update Date	:	10/12/2012

Similar Medicare Providers

1255588216 — WILLIE EDWARD JOHNSON MSW, LCSW
Practice Location Address:

7550 CONSTANTINOPLE AVE BLDG 2
LAS VEGAS, NV
89129-6505

Practice Phone: 702-421-5563
Practice Fax:

1972855591 — MRS. LATOYSHIA PARSON-BASS
Practice Location Address:

7550 CONSTANTINOPLE AVE
LAS VEGAS, NV
89129-6505

Practice Phone: 702-529-4755
Practice Fax:

1891047239 — MRS. ADRIENNE D WRIGHT-MCCOY
Practice Location Address:

7550 CONSTANTINOPLE AVE
LAS VEGAS, NV
89129-6505

Practice Phone: 702-529-4755
Practice Fax:

1164774501 — DEWAYNE MCCOY
Practice Location Address:

7550 CONSTANTINOPLE AVE
LAS VEGAS, NV
89129-6505

Practice Phone: 702-529-4755
Practice Fax:

1023066958 — EMMANUEL I OKECHUKWU M.D.
Practice Location Address:

11870 TEVARE LN UNIT 2084
LAS VEGAS, NV
89138-6505

Practice Phone: 702-210-2763
Practice Fax:

1497897128 — EMMANUEL OKECHUKWU MD PC
Practice Location Address:

11870 TEVARE LN UNIT 2084
LAS VEGAS, NV
89138-6505

Practice Phone: 702-210-2763
Practice Fax:

Directions to “ KEITH DARNELL JACKSON ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.