JEFFERY RAY TACKETT (NPI# 1376956789) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376956789 |
| Entity Type | Individual |
| Full Name | JEFFERY RAY TACKETT |
| Credential | APRN, PPCNP-C |
| Practice Address |
5575 S Durango Dr Ste 103 Las Vegas NV 89113-1834 |
| Mailing Address |
Po Box 98978 Las Vegas NV 89193-8978 |
| Practice Telephone | 7024355437 |
| Practice Fax Number | 7028519640 |
| Mailing Telephone | 7024575437 |
| Mailing Fax Number | 7024645801 |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2020-02-27 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
APRN002155 | NV | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
18745 | TN | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
5575 S DURANGO DR STE 103 |
| City | LAS VEGAS |
| State | NV |
| Zip Code | 89113-1834 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326400912 | David Rafferty | Pediatrics | 5575 S Durango Dr Ste 103, Las Vegas, NV 89113-1834 | 2016-03-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457951121 | Trang Thu Tran | Pharmacist | 7200 Arroyo Crossing Parkway, Las Vegas, NV 89113 | 2020-10-30 |
| 1457966293 | Cory Alexander Stattelman | Physical Medicine & Rehabilitation | 5575 N Durango Dr Suite 111, Las Vegas, NV 89113 | 2020-09-09 |
| 1477170801 | Hailey Eileen Wilson | Behavior Technician | 5575 S Durango Dr #102, Las Vegas, NV 89113 | 2020-07-01 |
| 1295385078 | Dominica Zaragoza | Technician | 711 S. Durango Dr, Las Vegas, NV 89113 | 2019-09-13 |
| 1831742758 | Lyass PC A Professional Medical Corp | Clinic/Center | 5950 S. Durgango Dr, Suite 100, Las Vegas, CA 89113 | 2019-07-19 |
| 1932679529 | Kiara Hayden | Rehabilitation Practitioner | 5509 Lonesome Biker Lane, Las Vegas, NV 89113 | 2018-11-27 |
| 1437631876 | James Eugene Hightower | Community Health Worker | 7455 Arroyo Crossing Pkwy Suite 220, Las Vegas, NV 89113 | 2018-09-01 |
| 1356822282 | Warda Ali | Nurse Practitioner | 8738 Pinley Spring St, Las Vegas, NV 89113 | 2018-08-28 |
| 1063992949 | Endure Recovery Services LLC | Counselor | 3087 E. Warm Srpings, Suite 200, Las Vegas, NV 89113 | 2018-08-20 |
| 1134635097 | Mivip Regional Surgery Center | Clinic/Center | 5950 S Durango Dr Ste 101, Las Vegas, NV 89113 | 2017-12-14 |
| Find all providers in zip 89113 | ||||
| Taxonomy Code | 363LP0200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Pediatrics |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740773183 | Julie Bascones | Nurse Practitioner | 3050 E Bonanza Rd Ste 130, Las Vegas, NV 89101-3706 | 2018-06-11 |
| 1770027708 | Rowena Cruz Garcia | Nurse Practitioner | 3100 W Charleston Blvd Ste 210, Las Vegas, NV 89102-1900 | 2016-12-09 |
| 1659756021 | Victoria Sijuade | Nurse Practitioner | 6850 N Durango Dr Ste 301, Las Vegas, NV 89149-4597 | 2015-07-27 |
| 1891001616 | Nikki Cuasay | Nurse Practitioner | 657 N Town Center Dr Fl 5, Las Vegas, NV 89144-6367 | 2010-08-31 |
| 1023338738 | Michaela Susan Brooks | Nurse Practitioner | 968 E Sahara Ave, Las Vegas, NV 89104-3022 | 2010-06-03 |
| 1861642480 | Tisha Saori Fujino | Nurse Practitioner | 6670 S. Tenaya Way #180, Las Vegas, NV 89113 | 2008-09-19 |
| 1871752303 | Meredith Nettles D'agostino | Nurse Practitioner | 500 N Rainbow Blvd Ste 300-345, Las Vegas, NV 89107-1082 | 2008-06-09 |
| 1023186889 | Jill Kathleen Schwartz | Nurse Practitioner | 10105 Banburry Cross Drive Suite 370, Las Vegas, NV 89144 | 2006-12-01 |
| 1861569824 | Olga R Kalbermatter | Nurse Practitioner | 1090 E Desert Inn Rd Ste 200, Las Vegas, NV 89109-2803 | 2006-11-28 |
| 1992809412 | Pokroy Medical Group of Nevada, Ltd. | Nurse Practitioner | 653 N Town Center Dr Ste 112, Las Vegas, NV 89144-0515 | 2006-09-13 |
| Find all providers in LAS VEGAS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.