Lieutenant Johnson Superville, PH.D

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

847157 Issued in NV

Practice address

6301 Mountain Vista St Ste 104
Henderson, NV 89014-2365

Phone

(512) 201-6766

NPI assigned

Jul 30, 2021

Sex

Female

Sole proprietor

No

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

Enrolled in NV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

Nova Southeastern College of Osteo Medicine, 2019

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lifes Challenges a Mental Health Consultant Firm

  • Psychiatric/Mental Health Nurse Practitioner
  • Henderson, NV
  • NPI 1184515934
  Medicare reassignment NPD

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

{
    "created_epoch": "1627603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788134400000",
    "number": "1790458156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6301 MOUNTAIN VISTA ST STE 104",
            "address_2": "SUITE 104",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890142365",
            "telephone_number": "702-785-2941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6301 MOUNTAIN VISTA ST STE 104",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890142365",
            "telephone_number": "512-201-6766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUPERVILLE",
        "first_name": "LIEUTENANT",
        "middle_name": "JOHNSON",
        "credential": "PH.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-30",
        "last_updated": "2026-08-31",
        "certification_date": "2026-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NV",
            "license": "847157",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sunset Vision Eyecare, LLC
• Sunshine Adult Day Care LLC
• Sunshine Adult Day Care LLC
• Superior Health Brown LTD
• Superior Home Health of Las Vegas LLC
• Carl Kevin Supnet, DO
• Samantha Aisha Susag
• Susan Maldonado Counseling PLLC
• Susan R Fernandez PC
• Susan Schwartz DO PC

• Psychiatric/Mental Health Nurse Practitioner in Henderson, NV
• Providers in Henderson, NV by specialty
• Psychiatric/Mental Health Nurse Practitioner in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.