Illisia Marie Johnston, NP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

F06212134 Issued in MS

Practice address

1008 N 15TH Ave
Laurel, MS 39440-2656

Phone

(601) 426-5125

NPI assigned

Jun 28, 2021

Sex

Female

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

Enrolled in MS

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

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

South Central Clinics, IncGroup PAC ID 4385876655, 117 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• South Central Clinics, Inc

  • Family Medicine Physician
  • Ellisville, MS
  • NPI 1801226287

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Jefferson Neurology Clinic, LLC

  • Clinic/Center
  • Laurel, MS
  • NPI 1518486943

  Single Specialty

  Medicare reassignment NPD
• South Central Clinics, Inc

  • Rural Health Clinic/Center
  • Laurel, MS
  • NPI 1033903547
  NPD
• South Central Clinics, Inc,

  • Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
  • Laurel, MS
  • NPI 1598017196
  NPD
• South Central Clinics, Inc.

  • Rural Health Clinic/Center
  • Ellisville, MS
  • NPI 1427098003
  NPD (past)

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

{
    "created_epoch": "1624838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727913600000",
    "number": "1003486556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 247",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394410247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1008 N 15TH AVE",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394402656",
            "telephone_number": "601-426-5125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSTON",
        "first_name": "ILLISIA",
        "middle_name": "MARIE",
        "credential": "NP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-28",
        "last_updated": "2024-10-03",
        "certification_date": "2024-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "F06212134",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karla Johnson, CRNA
• Linda C Johnson, LPN
• Mari Johnson
• Martha J Johnson, FNP
• Stephen Johnson, D.O.
• Jones County Medical Supplies, Inc
• Jones County School
• Jones County School District
• Jones Family Medicine Clinic PLLC
• Jones Family Medicine Clinic, PLLC

• Family Nurse Practitioner in Laurel, MS
• Providers in Laurel, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2024; 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.