Independent US Healthcare Provider Directory & Public Medical Database
Deactivated NPI 1841571478 Deactivated / Inactive NPI Female Practitioner

Willie Pearl Jackson

Behavior Analyst • Las Vegas, NV

⚠️

Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Willie Jackson has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date September 09, 2011
NPI Deactivation Date October 10, 2019
Total Practice Duration ~8 Years of Practice (2011 – 2019)

Professional Overview & Biography Verified Profile Summary

Willie Jackson was a registered Behavior Analyst practicing in Las Vegas, NV. Throughout an active medical career spanning 8 years, Willie Jackson provided care at the practice location at 5304 ROSELAND AVE until profile deactivation on 2019-10-10.

Practice Location & Contact Primary Location

Practice Address

5304 Roseland Ave

Las Vegas, NV 891302635

Telephone 7026305009
Fax 7026319821
Associated Practice Facility / Clinic
🏢 Elevate Life Facility NPI 1033436787

Specialty Benchmarks & Practice Insights

Comparative analytics for Behavior Analyst in Las Vegas, NV

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 7.5 Yrs
State Avg: 5.4 Yrs
Regional Practice Density
2900 Specialists

Practicing in Las Vegas, NV (4661 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Behavior Analyst Primary Specialty

NUCC Taxonomy Code: 103K00000X

A behavior analyst is qualified by at least a master's degree and Behavior Analyst Certification Board certification and/or a state-issued credential (such as a license) to practice behavior analysis independently. Behavior analysts provide the required supervision to assistant behavior analysts and behavior technicians. A behavior analyst delivers services consistent with the dimensions of applied behavior analysis. Common services may include, but are not limited to, conducting behavioral assessments, analyzing data, writing and revising behavior-analytic treatment plans, training others to implement components of treatment plans, and overseeing implementation of treatment plans.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
1841571478 (NV)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

4 Associated Practitioners
Vicki Alexander

Behavior Analyst

NPI 1366866261
Elsa De Castro

Rehabilitation Practitioner

NPI 1578995916
Sheila Alston

Rehabilitation Practitioner

NPI 1598107930
Jackie Johnson

Behavior Analyst

NPI 1740692318

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

16 Historical Events
📍
Updated Practice Location October 18, 2019

Registered at 5304 ROSELAND AVE, LAS VEGAS, NV 891302635 (Tel: 7026305009)

📍
Updated Business Mailing Address October 18, 2019

Registered at 5304 ROSELAND AVE, LAS VEGAS, NV 891302635 (Tel: 7026305009)

👤
Provider Name / Credentials Updated October 18, 2019

Recorded as WILLIE JACKSON

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) October 18, 2019

Behavior Analyst

⚠️
NPI Profile Deactivated October 10, 2019

Record deactivated on October 10, 2019

NPI Profile Active March 07, 2017

NPI status registered as active in NPPES database

📍
Updated Practice Location March 07, 2017

Registered at 5304 ROSELAND AVE, LAS VEGAS, NV 891302635 (Tel: 7026305009)

📍
Updated Business Mailing Address March 07, 2017

Registered at 5304 ROSELAND AVE, LAS VEGAS, NV 891302635 (Tel: 7026305009)

👤
Provider Name / Credentials Updated March 07, 2017

Recorded as WILLIE JACKSON

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) March 07, 2017

Behavior Analyst

NPI Profile Active September 09, 2011

NPI status registered as active in NPPES database

📍
Updated Practice Location September 09, 2011

Registered at 37 W OWENS AVE, N LAS VEGAS, NV 890306865 (Tel: 7026390277)

📍
Updated Business Mailing Address September 09, 2011

Registered at 37 W OWENS AVE, N LAS VEGAS, NV 890306865 (Tel: 7026390277)

👤
Provider Name / Credentials Updated September 09, 2011

Recorded as WILLIE JACKSON

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) September 09, 2011

Social Worker

🟢
Initial NPI Registration & Enumeration September 09, 2011

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

0 Reviews
No patient reviews submitted yet for Willie Jackson. Be the first to share your experience!

Sign in to leave a review for Willie Jackson

Only verified registered users can submit ratings, post feedback, and upload facility photos.

NPI Administrative Meta

NPI Number: 1841571478
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: September 09, 2011
Last Update: October 18, 2019
Deactivation Date: October 10, 2019
Sole Proprietor: Yes

Mailing Address

5304 Roseland Ave

Las Vegas, NV 891302635

Phone: 7026305009

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.