Individual provider Active NPI

Jermaine Love Williams

  • Recreation Therapist
  • North Las Vegas, NV
National Provider Identifier
1386119337
Registry record updated Oct 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Recreation TherapistTaxonomy code 225800000X
Practice address
1409 E Lake Mead Blvd
North Las Vegas, NV 89030-7120
Phone
(702) 649-7711
NPI assigned
Oct 5, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Recreation Therapist 225800000X Primary

Addresses

Primary practice location

1409 E Lake Mead Blvd
North Las Vegas, NV 89030-7120

Mailing address

1409 E Lake Mead Blvd
North Las Vegas, NV 89030-7120
Phone (702) 649-7711

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

NPI Registry JSON

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

{
    "created_epoch": "1538697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538697600000",
    "number": "1386119337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1409 E LAKE MEAD BLVD",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890307120",
            "telephone_number": "702-649-7711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1409 E LAKE MEAD BLVD",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890307120",
            "telephone_number": "702-649-7711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "JERMAINE",
        "middle_name": "LOVE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-10-05",
        "last_updated": "2018-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225800000X",
            "taxonomy_group": "",
            "desc": "Recreation Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 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.

Verify at the official NPI Registry.