Individual provider Active NPI

Demetia Encarnacion Jackson

  • Personal Care Attendant
  • Las Vegas, NV
National Provider Identifier
1609376516
Registry record updated Feb 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Personal Care AttendantTaxonomy code 3747P1801X
Practice address
3050 N Jones Blvd Apt 2070
Las Vegas, NV 89108-6559
Phone
(702) 955-0575
NPI assigned
Feb 16, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2018

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Chore Provider 372500000X
Adult Companion 372600000X
Personal Care Attendant 3747P1801X Primary
Attendant Care Provider 3747A0650X
Homemaker 376J00000X

Addresses

Primary practice location

3050 N Jones Blvd Apt 2070
Las Vegas, NV 89108-6559

Mailing address

7320 Smoke Ranch Rd Ste H
Las Vegas, NV 89128-0259

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": "1518739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1518739200000",
    "number": "1609376516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7320 SMOKE RANCH RD STE H",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891280259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3050 N JONES BLVD APT 2070",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891086559",
            "telephone_number": "702-955-0575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENCARNACION JACKSON",
        "first_name": "DEMETIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-16",
        "last_updated": "2018-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "372500000X",
            "taxonomy_group": "",
            "desc": "Chore Provider",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "372600000X",
            "taxonomy_group": "",
            "desc": "Adult Companion",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3747P1801X",
            "taxonomy_group": "",
            "desc": "Technician, Personal Care Attendant",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3747A0650X",
            "taxonomy_group": "",
            "desc": "Technician, Attendant Care Provider",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "376J00000X",
            "taxonomy_group": "",
            "desc": "Homemaker",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "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 Feb 16, 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.