Provider Demographics
NPI:1932833241
Name:MCKNEELY, JASMINE ARIEL
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:ARIEL
Last Name:MCKNEELY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7960 RAFAEL RIVERA WAY UNIT 1493
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-5374
Mailing Address - Country:US
Mailing Address - Phone:702-498-7769
Mailing Address - Fax:
Practice Address - Street 1:7220 S CIMARRON RD STE 210
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-2102
Practice Address - Country:US
Practice Address - Phone:702-368-2380
Practice Address - Fax:702-442-7455
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-12
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No172V00000XOther Service ProvidersCommunity Health Worker