Demetrius Whitehead, LPN

Primary specialty

Physical Disabilities Residential Treatment FacilityTaxonomy code 320700000X

License

21015321 Issued in IN

Practice address

415 S Butler Ave
Indianapolis, IN 46219-7034

Phone

(317) 499-0437

NPI assigned

Jan 8, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1578441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709078400000",
    "number": "1346880341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 S BUTLER AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462197034",
            "telephone_number": "317-409-1422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 S BUTLER AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462197034",
            "telephone_number": "317-499-0437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITEHEAD",
        "first_name": "DEMETRIUS",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-01-08",
        "last_updated": "2024-02-28",
        "certification_date": "2024-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Licensed Practical Nurse",
            "state": "IN",
            "license": "27060564A",
            "primary": false
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "IN",
            "license": "21015321",
            "primary": false
        },
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "IN",
            "license": "21015321",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walter Guy White, MSPT
• Whitney Breanne White, BCBA
• Yvette Renee White, MS,CCC-SLP
• Jason T Whitefoot, CRNA
• Anne C Whitehead, MD
• Kay E Whitehead, M.S.W., L.C.S.W., CT
• Kevin Moses Whitehead, ED.S
• Precious Whitehead
• Sandra Whiteley, LCSW
• Rocio Del Carmen Whitelock

• Physical Disabilities Residential Treatment Facility in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Physical Disabilities Residential Treatment Facility in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2024; 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.