Provider Demographics
NPI:1083231831
Name:DEMEREST, JAMES DARRELL (MSBS, PA-C, RDN)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:DARRELL
Last Name:DEMEREST
Suffix:
Gender:M
Credentials:MSBS, PA-C, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 HAWTHORNE RDG
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48390-3917
Mailing Address - Country:US
Mailing Address - Phone:734-625-4572
Mailing Address - Fax:
Practice Address - Street 1:1825 HAWTHORNE RDG
Practice Address - Street 2:
Practice Address - City:COMMERCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48390-3917
Practice Address - Country:US
Practice Address - Phone:734-625-4572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-28
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86150187133V00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered