Provider Demographics
NPI:1689242471
Name:JASPER, COREY ANTHONY
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:ANTHONY
Last Name:JASPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3053 W CRAIG RD STE E209
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-5124
Mailing Address - Country:US
Mailing Address - Phone:702-426-6010
Mailing Address - Fax:702-537-8757
Practice Address - Street 1:3053 W CRAIG RD # E209
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-5124
Practice Address - Country:US
Practice Address - Phone:702-426-6010
Practice Address - Fax:702-537-8757
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor