Keona Jewel Tillmon

Primary specialty

Other TechnicianTaxonomy code 247200000X

Practice address

3920 W Charleston Blvd Ste O
Las Vegas, NV 89102-1633

Phone

(702) 784-5541

Fax

(702) 915-7664

NPI assigned

Jun 18, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1560816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560816000000",
    "number": "1003476383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3920 W CHARLESTON BLVD STE O",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891021633",
            "telephone_number": "702-784-5541",
            "fax_number": "702-915-7664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3920 W CHARLESTON BLVD STE O",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891021633",
            "telephone_number": "702-784-5541",
            "fax_number": "702-915-7664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLMON",
        "first_name": "KEONA",
        "middle_name": "JEWEL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-18",
        "last_updated": "2019-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "247200000X",
            "taxonomy_group": "",
            "desc": "Technician, Other",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "keona32781@gmail.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3920 W Charleston Blvd Ste O",
            "city": "Las Vegas",
            "state": "NV",
            "country_code": "US",
            "postal_code": "891021633",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Phyllis Tillman
• Queneshia Tillman
• Sammiyyah Jadora Tillman
• Tiara Raquel Tillman
• Michelle Tillmas
• Scott Tillotson
• Debra Ann Tilton, OTR
• Jennie Hawkes Tilton, MARRIAGE AND FAMILY
• Tiltons Therapy Inc
• Tiltons Therapy Inc

• Other Technician in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Other Technician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.