MEDICARE: ZEPHRA 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1629527817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZEPHRA JACKSON

Provider Business Mailing Address
First Line	:	3428 CANTER DR
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-2404
Country	:	US
Telephone Number	:	702-206-2328
Fax Number	:

Provider Business Practice Location Address
First Line	:	1428 DESERT RIDGE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-5003
Country	:	US
Telephone Number	:	702-206-2328
Fax Number	:

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

Provider Enumeration Date	:	09/28/2016
Last Update Date	:	09/28/2016

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Directions to “ ZEPHRA JACKSON ” Practice Location

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