Provider Demographics
NPI:1013358183
Name:JACKSON, MARKQUETTA RENEE (PMHNP)
Entity type:Individual
Prefix:MS
First Name:MARKQUETTA
Middle Name:RENEE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 PASEO VERDE PKWY STE 190
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2703
Mailing Address - Country:US
Mailing Address - Phone:702-589-4871
Mailing Address - Fax:
Practice Address - Street 1:406 BLANKENBAKER PKWY STE C1
Practice Address - Street 2:
Practice Address - City:DOUGLASS HILLS
Practice Address - State:KY
Practice Address - Zip Code:40243-1881
Practice Address - Country:US
Practice Address - Phone:502-654-9575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV842906363LF0000X
KY3008203363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily