Nicole Marie Johnson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

8975784-1206 Issued in UT

Practice address

7302 S Bingham Junction Blvd
Midvale, UT 84047-4804

Phone

(801) 442-5502

NPI assigned

Jan 19, 2011

Last updated

Jun 23, 2020By the provider in NPPES

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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jul 1, 2024 through Jul 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Interoperability endpoints

• Direct secure messaging: nicole.johnson@556775270121476.direct.elationemr.com

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

{
    "created_epoch": "1295395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592870400000",
    "number": "1033414248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27128",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841270128",
            "telephone_number": "801-442-5502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7302 S BINGHAM JUNCTION BLVD",
            "city": "MIDVALE",
            "state": "UT",
            "postal_code": "840474804",
            "telephone_number": "801-442-5502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "name_prefix": "Miss",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-01-19",
        "last_updated": "2020-06-23",
        "certification_date": "2020-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "8975784-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aubrey Anne Jenson, COTA
• Isabella Jenson, OD
• Jentle Care
• Crystal Leigh Jimenez
• Hena John-Fisk, CSWI
• Shawnee Johnson
• Tanner Derek Nephi Johnson
• Jared Alan Johnstun, M.D.
• Annelise Larue Jolley
• Carlee Marie Jones, LCSW

• Physician Assistant in Midvale, UT
• Providers in Midvale, UT by specialty
• Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2020; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.