NPIMap

Individual provider Active NPI

Debralee Denise Johnson, FNP

  • Family Nurse Practitioner
  • Kayenta, AZ
National Provider Identifier
1083855860
Registry record updated Sep 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
219637 Issued in AZ
Practice address
Hwy 160, S M.P. 394.3
Kayenta, AZ 86033-0368
Phone
(928) 697-4000
Fax
(928) 697-4145
NPI assigned
Mar 9, 2009
Last updated
Sep 10, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 219637 AZ Primary
Registered Nurse 163W00000X 171941 AZ

Addresses

Primary practice location

Hwy 160, S M.P. 394.3
Kayenta, AZ 86033-0368

Mailing address

PO Box 368
Kayenta, AZ 86033-0368
Phone (928) 697-4000

Other identifiers 1

IdentifierTypeStateIssuer
060012MedicaidAZ

Other names 1

  • Debralee Denise Gorman Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191030000335 TX Practitioner - Nurse Practitioner 3173855855 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

US Hwy 160 S
MP 394
Kayenta, AZ 86033-0368
Phone (928) 697-4000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
171941AZMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Dhew Ind HLTH SV HLTH SVS & MNTL HLTH Adm CurrentSince Dec 18, 2022 Accepting new patients
Kayenta Alternative Rural Hospital CurrentSince Sep 5, 2019 Accepting new patients
Kayenta Alternative Rural Hospital CurrentSince Jun 11, 2023 Accepting new patients
Dhew Ind HLTH SV HLTH SVS & MNTL HLTH Adm CurrentSince Dec 18, 2022 Accepting new patients
Kayenta Alternative Rural Hospital CurrentSince Sep 5, 2019 Accepting new patients

Locations

4212 N 16th St
Phoenix, AZ 85016
Phone (602) 248-4187

Organizations & group practices 5

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 2

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": "1236556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568073600000",
    "number": "1083855860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 368",
            "city": "KAYENTA",
            "state": "AZ",
            "postal_code": "860330368",
            "telephone_number": "928-697-4000",
            "fax_number": "928-697-4145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HWY 160, S M.P. 394.3",
            "city": "KAYENTA",
            "state": "AZ",
            "postal_code": "860330368",
            "telephone_number": "928-697-4000",
            "fax_number": "928-697-4145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "DEBRALEE",
        "middle_name": "DENISE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-09",
        "last_updated": "2019-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "219637",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AZ",
            "license": "171941",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060012",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DEBRALEE",
            "last_name": "GORMAN",
            "middle_name": "DENISE",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Kayenta, AZ

Sources for this page

Verify at the official NPI Registry.