Active NPI
Johanna McKiddy
- Social Worker
- Las Vegas, NV
National Provider Identifier
1528502192
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 7097-S
- Practice address
- 3513 E Russell Rd Ste D
Las Vegas, NV 89120-2244 - Phone
- (702) 826-3334
- NPI assigned
- Dec 15, 2016
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 7097-S | NV | Primary |
Addresses
Primary practice location
3513 E Russell Rd Ste D
Las Vegas, NV 89120-2244
Mailing address
3513 E Russell Rd Ste D
Las Vegas, NV 89120-2244
Phone (702) 826-3334
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 813759684 | Medicaid | NV |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7097-S | NV | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1481760000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1481760000000",
"number": "1528502192",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3513 E RUSSELL RD STE D",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891202244",
"telephone_number": "702-826-3334"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3513 E RUSSELL RD STE D",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891202244",
"telephone_number": "702-826-3334"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCKIDDY",
"first_name": "JOHANNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-12-15",
"last_updated": "2016-12-15",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NV",
"license": "7097-S",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "813759684",
"state": "NV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.