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NPI Code Detail

MEDICARE: SIMONE JACKSON NP

MEDICARE: SIMONE JACKSON NP
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAPRN002716NV
2363LF0000XFamily Nurse PractitionerAPRN002716NV
3363LF0000XFamily Nurse PractitionerAP134295TX

General Provider Information

NPI Number : 1134644396
Entity Type Code : Individual
Provider Name (Legal Business Name) : SIMONE JACKSON NP
Provider Business Mailing Address
First Line : 9005 W OQUENDO RD APT 3036
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-1524
Country : US
Telephone Number : 901-283-1975
Fax Number :
Provider Business Practice Location Address
First Line : 101 CONVENTION CENTER DR STE 900
Second Line :
City : LAS VEGAS
State : NV
Zip : 89109-2039
Country : US
Telephone Number : 702-355-8294
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2017
Last Update Date : 12/15/2025

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