Individual provider Active NPI

Katheryn M Johnston, FNP-C

  • Family Nurse Practitioner
  • Show Low, AZ
National Provider Identifier
1083262620
Registry record updated Apr 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
225636 Issued in AZ
Practice address
4951 S White Mountain Rd BLDG a
Show Low, AZ 85901-7827
Phone
(928) 537-6700
Fax
(928) 532-2199
NPI assigned
Aug 27, 2019
Last updated
Apr 12, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 225636 AZ
Family Nurse Practitioner 363LF0000X 225636 AZ Primary

Addresses

Primary practice location

4951 S White Mountain Rd BLDG a
Show Low, AZ 85901-7827

Mailing address

4951 S White Mountain Rd BLDG a
Show Low, AZ 85901-7827
Phone (928) 537-6700

Other practice location 1

210 N Center St
Mesa, AZ 85201-6600
Phone (480) 834-5414

Other identifiers 1

IdentifierTypeStateIssuer
008465MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, TX2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20210311001273 AZ Practitioner - Nurse Practitioner 0345572459 Reassigns benefits to 1 organization
I20231011004143 TX Practitioner - Nurse Practitioner 0345572459 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4951 S White Mountain Rd
BLDG a
Show Low, AZ 85901-7801
Phone (928) 537-6700

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
225636AZMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Healthcare Medical Associates CurrentSince Oct 1, 2023 Accepting new patients
Summit Healthcare Association Nurse Practitioner Current Accepting new patients
An Oasis of Healing, PLC Current Accepting new patients
DHHS IHS Phoenix Area CurrentSince Aug 6, 2023 Accepting new patients
DHHS IHS Phoenix Area CurrentSince Aug 6, 2023 Accepting new patients
Summit Healthcare Medical Associates Nurse Practitioner CurrentSince Oct 1, 2023 Accepting new patients
Summit Healthcare Association Past Accepting new patients

Locations

210 N Center St
Ste 102
Mesa, AZ 85201
Phone (480) 361-2121

2200 E Show Low Lake Rd
Show Low, AZ 85901
Phone (928) 537-4375

4951 S White Mountain Rd
Show Low, AZ 85901
Phone (928) 228-8384

4951 S White Mountain Rd
Bldg A
Show Low, AZ 85901
Phone (928) 532-3926

1121 S Main St
Snowflake, AZ 85937
Phone (928) 532-3008

Interoperability endpoints

  • Direct secure messaging: katherynjohnston@shrmcshma.allscriptsdirect.net

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1566864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712880000000",
    "number": "1083262620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4951 S WHITE MOUNTAIN RD BLDG A",
            "city": "SHOW LOW",
            "state": "AZ",
            "postal_code": "859017827",
            "telephone_number": "928-537-6700",
            "fax_number": "928-532-2199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4951 S WHITE MOUNTAIN RD BLDG A",
            "city": "SHOW LOW",
            "state": "AZ",
            "postal_code": "859017827",
            "telephone_number": "928-537-6700",
            "fax_number": "928-532-2199"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "210 N Center St",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852016600",
            "country_code": "US",
            "telephone_number": "480-834-5414",
            "fax_number": "480-834-5418",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSTON",
        "first_name": "KATHERYN",
        "middle_name": "M",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-27",
        "last_updated": "2024-04-12",
        "certification_date": "2024-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AZ",
            "license": "225636",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "225636",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008465",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Show Low, AZ

Sources for this page

Verify at the official NPI Registry.