Provider Demographics
NPI:1134618531
Name:ARAGON, JACKIE L (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:JACKIE
Middle Name:L
Last Name:ARAGON
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:L
Other - Last Name:ARAGON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:608 PROUD EAGLE LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-0912
Mailing Address - Country:US
Mailing Address - Phone:702-575-4360
Mailing Address - Fax:
Practice Address - Street 1:410 S RAMPART BLVD STE 390
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-5749
Practice Address - Country:US
Practice Address - Phone:702-901-9451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002869363LP0808X, 363LF0000X
NVRN38178163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse