MEDICARE: NICHOLE 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	106H00000X	Marriage & Family Therapist	4763	NV

General Provider Information

NPI Number	:	1477890952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLE JACKSON

Provider Business Mailing Address
First Line	:	2723 E RUSSELL RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-2426
Country	:	US
Telephone Number	:	725-205-0734
Fax Number	:	702-522-6080

Provider Business Practice Location Address
First Line	:	2723 E RUSSELL RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-2426
Country	:	US
Telephone Number	:	725-205-0734
Fax Number	:	702-522-6080

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

Provider Enumeration Date	:	01/03/2013
Last Update Date	:	05/04/2026

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Directions to “ NICHOLE JACKSON ” Practice Location

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