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SHAW JACKSON JR
NPI 1902773831
Technician - Personal Care Attendant in Las Vegas, NV

Active since October 23, 2025
4245 S GRAND CANYON DR, LAS VEGAS, NV 89147(702) 825-8106 Get Directions Write a Review

NPPES record last updated: October 23, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Shaw Jackson Jr NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHAW JACKSON JR (NPI 1902773831) is an individual personal care attendant in Las Vegas, Nevada and active in the NPI registry since October 2025.

NPPES Registry Identity

NPI1902773831
Entity TypeIndividualMale
Primary Taxonomy3747P1801X
Provider Legal NameSHAW JACKSON JR
Location Address4245 S GRAND CANYON DRLas Vegas, NV 89147-7161
Mailing Address4245 S Grand Canyon DrLas Vegas, NV 89147-7161 · (702) 825-8106
Phone(702) 825-8106
Sole ProprietorNo
Enumeration DateOctober 23, 2025
NPPES CertifiedOctober 23, 2025
✔ NPI 1902773831 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyTechnician · Personal Care AttendantNursing Service Related Providers
Taxonomy Code3747P1801X
Definition
An individual who provides assistance with eating, bathing, dressing, personal hygiene, activities of daily living as specified in the plan of care. Services which are incidental to the care furnished, or essential to the health and welfare of the individual may also be provided. Personal care providers must meet state defined training and certification standards
4245 S GRAND CANYON DR, Las Vegas, NV 89147
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SUMMERLIN SMILES
Dentist (General Practice)
4245 S GRAND CANYON DR, STE 108
LAS VEGAS, NV 89147
Clark County (702) 579-7645
DATONYA WADE
Technician (Personal Care Attendant)
4245 S GRAND CANYON DR
LAS VEGAS, NV 89147
Clark County (725) 745-3741
ANIKA VIGIL-FLEMING
Technician (Personal Care Attendant)
4245 S GRAND CANYON DR
LAS VEGAS, NV 89147
Clark County (725) 745-3741
NOAH CORONADO
Technician (Personal Care Attendant)
4245 S GRAND CANYON DR
LAS VEGAS, NV 89147
Clark County (725) 745-3741
EVONNE RANDALL
Technician (Personal Care Attendant)
4245 S GRAND CANYON DR
LAS VEGAS, NV 89147
Clark County (725) 745-3741
LORIANN PETZEL
Technician (Personal Care Attendant)
4245 S GRAND CANYON DR
LAS VEGAS, NV 89147
Clark County (725) 745-3741
JAMIE PONNELL
Technician (Personal Care Attendant)
4245 S GRAND CANYON DR
LAS VEGAS, NV 89147
Clark County (725) 745-3741
ILLYANNA SHEVCHENKO
Technician (Personal Care Attendant)
4245 S GRAND CANYON DR
LAS VEGAS, NV 89147
Clark County (725) 745-3741

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shaw Jackson Jr's NPI number?

The NPI number for Shaw Jackson Jr is 1902773831. It was assigned to this individual provider in the NPPES registry on October 23, 2025.

Where is Shaw Jackson Jr located?

Shaw Jackson Jr practices at 4245 S Grand Canyon Dr, Las Vegas, NV 89147. The listed phone number is (702) 825-8106.

What is Shaw Jackson Jr's specialty?

The primary specialty registered for this NPI is Technician, specializing in Personal Care Attendant, with taxonomy code 3747P1801X.

When was this NPI record last updated?

The NPPES record for Shaw Jackson Jr was last updated on October 23, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.