Active NPI
Johann Nicholas Prewett, PH.D.
- Psychologist
- Orange Park, FL
National Provider Identifier
1972539690
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PY 4331
- Practice address
- 1726 Kingsley Ave
Suite 12
Orange Park, FL 32073-4463 - Phone
- (904) 269-6071
- Fax
- (904) 269-6642
- NPI assigned
- Jun 24, 2006
- Last updated
- Aug 23, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PY 4331 | FL | Primary |
| Clinical Child & Adolescent Psychologist | 103TC2200X | PY 4331 | FL |
Addresses
Primary practice location
1726 Kingsley Ave
Suite 12
Orange Park, FL 32073-4463
Mailing address
3720 Beach Blvd
Jacksonville, FL 32207-3814
Phone (904) 475-2039
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
- HHS exclusion list flag
- CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found.
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY 4331 | FL | MD | Clinical Child & Adolescent Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| J Nicholas Prewett PHD & Associates PA | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Clinical Psychologist
- Orange Park, FL
- NPI 1134276140
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151107200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1503446400000",
"number": "1972539690",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3720 BEACH BLVD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322073814",
"telephone_number": "904-475-2039"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1726 KINGSLEY AVE",
"address_2": "SUITE 12",
"city": "ORANGE PARK",
"state": "FL",
"postal_code": "320734463",
"telephone_number": "904-269-6071",
"fax_number": "904-269-6642"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PREWETT",
"first_name": "JOHANN",
"middle_name": "NICHOLAS",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-24",
"last_updated": "2017-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "FL",
"license": "PY 4331",
"primary": true
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "FL",
"license": "PY 4331",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orange Park, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.