Active NPI
Demond Lavar Shields, E.M.T.
- Basic Emergency Medical Technician
- Marion, AR
National Provider Identifier
1003384041
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Basic Emergency Medical Technician
- License
- 23601
- Practice address
- 130 Barton CV
Marion, AR 72364-1601 - Phone
- (901) 828-8832
- NPI assigned
- Nov 7, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Basic Emergency Medical Technician | 146N00000X | 23601 | AR | Primary |
Addresses
Primary practice location
130 Barton CV
Marion, AR 72364-1601
Mailing address
130 Barton CV
Marion, AR 72364-1601
Phone (901) 828-8832
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Emergency Medical Technician
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23601 | AR | MD | Basic Emergency Medical Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1541548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1541548800000",
"number": "1003384041",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "130 BARTON CV",
"city": "MARION",
"state": "AR",
"postal_code": "723641601",
"telephone_number": "901-828-8832"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 BARTON CV",
"city": "MARION",
"state": "AR",
"postal_code": "723641601",
"telephone_number": "901-828-8832"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIELDS",
"first_name": "DEMOND",
"middle_name": "LAVAR",
"credential": "E.M.T.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-11-07",
"last_updated": "2018-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "146N00000X",
"taxonomy_group": "",
"desc": "Emergency Medical Technician, Basic",
"state": "AR",
"license": "23601",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marion, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.