Demetrius De'Shon Johnson

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

255 Sands Ave
2515 S Bruce St
Las Veas, NV 89169

Phone

(602) 704-6917

NPI assigned

Oct 31, 2022

Last updated

Oct 31, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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": "1667174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667174400000",
    "number": "1093422180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2515 S BRUCE ST",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891691773",
            "telephone_number": "602-704-6917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 SANDS AVE",
            "address_2": "2515 S BRUCE ST",
            "city": "LAS VEAS",
            "state": "NV",
            "postal_code": "89169",
            "telephone_number": "602-704-6917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "DEMETRIUS",
        "middle_name": "DE'SHON",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-10-31",
        "last_updated": "2022-10-31",
        "certification_date": "2022-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2022; 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.