Individual provider Active NPI

Debra Johnson, PH.D.

  • Psychologist
  • Overland Park, KS
National Provider Identifier
1063502474
Registry record updated Nov 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
902 Issued in KS
Practice address
7501 College Blvd.
Suite 250
Overland Park, KS 66210-1944
Phone
(913) 451-8550
Fax
(913) 469-5266
NPI assigned
Oct 14, 2006
Last updated
Nov 5, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 902 KS Primary

Addresses

Primary practice location

7501 College Blvd.
Suite 250
Overland Park, KS 66210-1944

Mailing address

7501 College Blvd.
Suite 250
Overland Park, KS 66210-1944
Phone (913) 451-8550

Other identifiers 2

IdentifierTypeStateIssuer
23048031OtherMOBCBS KC
23048031OtherKSBCBS KC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
902KSMDPsychologist

NPI Registry JSON

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

{
    "created_epoch": "1160784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1225843200000",
    "number": "1063502474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7501 COLLEGE BLVD.",
            "address_2": "SUITE 250",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662101944",
            "telephone_number": "913-451-8550",
            "fax_number": "913-469-5266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7501 COLLEGE BLVD.",
            "address_2": "SUITE 250",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662101944",
            "telephone_number": "913-451-8550",
            "fax_number": "913-469-5266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "DEBRA",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-14",
        "last_updated": "2008-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "KS",
            "license": "902",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS KC",
            "identifier": "23048031",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS KC",
            "identifier": "23048031",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Overland Park, KS

Sources for this page

Verify at the official NPI Registry.