Patrice Johnell, MSN, FNP-BC
Individual provider Active NPI Family Nurse Practitioner · Ocean Park, WA
NPI 1053640656 · NPPES record last updated Oct 19, 2020
Key facts
- NPI
- 1053640656
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- AP60697111 (WA)
- Practice address
- 21610 Pacific Hwy
Ocean Park, WA 98640-9864 - Phone
- (360) 665-3000
- NPI assigned
- Dec 10, 2009
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science - Nursing, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN-128942 | CO | MD | Registered Nurse |
| RN-9246598 | FL | MD | Registered Nurse |
| NP-10143 | CO | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Banner Medical Group Greeley LLC | Past | Accepting new patients | |
| Big Thompson Medical Group Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN-128942 | CO | |
| Registered Nurse | 163W00000X | RN-9246598 | FL | |
| Family Nurse Practitioner | 363LF0000X | NP-10143 | CO | |
| Family Nurse Practitioner | 363LF0000X | AP60697111 | WA | Yes |
Addresses
Primary practice location
21610 Pacific Hwy
Ocean Park, WA 98640-9864
Mailing address
4468 Clipper CV
Destin, FL 32541-3699
Phone (970) 371-7120
Other practice location 1
1800 15th St Ste 200
Greeley, CO 80631-4563
Phone (970) 378-4434
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 28528506 | Medicaid | CO |
Other providers in Ocean Park, WA
- Melissa Gritz
- Nikki Lee Hartley-Jonason
- Durinda Haukap
- Kristopher Henderson
- Deborah Hoenig
- Nyna Rose Krause/Beadle
- Mihaela Lebo
- Jerome March
- April McCune
- Kevin P McGinley
All providers in Ocean Park, WA · Family Nurse Practitioner in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 19, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.