Kathryn Elsie Johnson, CPNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

2017000765 Issued in MO

Practice address

1195 N Oakland Ave Ste 2
Bolivar, MO 65613-8025

Phone

(417) 777-2121

NPI assigned

Apr 21, 2016

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 MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Pediatric Nurse Practitioner, Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/18256/brand/1/csg/1/fhir/r4

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.

• Citizens Memorial Healthcare

  • Surgery Physician
  • Bolivar, MO
  • NPI 1568566131
  Medicare reassignment NPD
• Citizens Memorial Healthcare

  • Rural Health Clinic/Center
  • Willard, MO
  • NPI 1568127397
  NPD

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

{
    "created_epoch": "1461196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769558400000",
    "number": "1003260472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1195 N OAKLAND AVE STE 2",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656138025",
            "telephone_number": "417-777-2121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1195 N OAKLAND AVE STE 2",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656138025",
            "telephone_number": "417-777-2121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KATHRYN",
        "middle_name": "ELSIE",
        "credential": "CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-21",
        "last_updated": "2026-01-28",
        "certification_date": "2026-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MO",
            "license": "2017000765",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Jennings, MS, RD, LD
• Zachary Jennings
• Todd Allen John, ATC/L
• Justin Lee Johns, LCSW
• Gbemisola Oluwakemi Johnson, MD
• Sarah Ann Jones, PT
• Jump Dental, LLC
• Donald R Jump, DDS
• Timothy R Jump, DDS
• Sarah B Kallberg, D.O.

• Pediatric Nurse Practitioner in Bolivar, MO
• Providers in Bolivar, MO by specialty
• Pediatric Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.