Provider Demographics
NPI:1861869703
Name:NGALAME, JACKLINE B (PMHNP)
Entity type:Individual
Prefix:DR
First Name:JACKLINE
Middle Name:B
Last Name:NGALAME
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:DR
Other - First Name:JACKLINE
Other - Middle Name:B
Other - Last Name:TABE -AYUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10409 PACIFIC PALISADES AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-1221
Mailing Address - Country:US
Mailing Address - Phone:702-281-8941
Mailing Address - Fax:440-597-4344
Practice Address - Street 1:10409 PACIFIC PALISADES AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-1221
Practice Address - Country:US
Practice Address - Phone:702-281-8941
Practice Address - Fax:440-597-4344
Is Sole Proprietor?:No
Enumeration Date:2015-08-26
Last Update Date:2025-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV839166363LP0808X
NY343912363LF0000X
FLAPRN11018101363LP0808X
KS53-78727-072363LP0808X
MN9142363LP0808X
NY402559363LP0808X
WAAP60741863363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily