Johnathon Kevin Stevens, LMT

Primary specialty

ContractorTaxonomy code 171W00000X

License

MA59178 Issued in FL

Practice address

1900 Palm Bay Rd NE
Suite D
Palm Bay, FL 32905-2955

Phone

(321) 208-1316

NPI assigned

Mar 29, 2011

Last updated

Mar 29, 2011By 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

State licenses

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

{
    "created_epoch": "1301356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1301356800000",
    "number": "1720377807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1245 PALM BAY RD NE",
            "address_2": "APT L 203",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329057620",
            "telephone_number": "321-208-1316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 PALM BAY RD NE",
            "address_2": "SUITE D",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329052955",
            "telephone_number": "321-208-1316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEVENS",
        "first_name": "JOHNATHON",
        "middle_name": "KEVIN",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-03-29",
        "last_updated": "2011-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "",
            "desc": "Contractor",
            "state": "FL",
            "license": "MA59178",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Contractor in Palm Bay, FL
• Providers in Palm Bay, FL by specialty
• Contractor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2011; 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.