Active NPI
Aimee D Johnson, LPN
- Licensed Practical Nurse
- Kelso, WA
National Provider Identifier
1104716059
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- LP61040781
- Practice address
- 305 Pacific Ave S Ste C
Kelso, WA 98626-1638 - Phone
- (360) 808-1916
- Fax
- (360) 808-1916
- NPI assigned
- Jul 3, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | LP61040781 | WA | Primary |
Addresses
Primary practice location
305 Pacific Ave S Ste C
Kelso, WA 98626-1638
Mailing address
305 Pacific Ave S Ste C
Kelso, WA 98626-1638
Phone (360) 808-1916
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP61040781 | WA | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1751500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1754265600000",
"number": "1104716059",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "305 PACIFIC AVE S STE C",
"city": "KELSO",
"state": "WA",
"postal_code": "986261638",
"telephone_number": "360-808-1916"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "305 PACIFIC AVE S STE C",
"city": "KELSO",
"state": "WA",
"postal_code": "986261638",
"telephone_number": "360-808-1916",
"fax_number": "360-808-1916"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "AIMEE",
"middle_name": "D",
"credential": "LPN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-07-03",
"last_updated": "2025-08-04",
"certification_date": "2025-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "WA",
"license": "LP61040781",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kelso, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.