Individual provider Active NPI

Kimberly A Kight Johansen, CNM

  • Advanced Practice Midwife
  • Seattle, WA
National Provider Identifier
1104890698
Registry record updated Apr 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
AP60305993 Issued in WA
Practice address
1959 NE Pacific St.
Seattle, WA 98195-0001
Phone
(206) 520-5000
NPI assigned
Feb 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Advanced Practice Midwife 367A00000X AP60305993 WA Primary

Addresses

Primary practice location

1959 NE Pacific St.
Seattle, WA 98195-0001

Mailing address

PO Box 50095
Seattle, WA 98145-5095

Other practice location 1

1440 Pleasant St
Suite 1
Des Moines, IA 50314-1728
Phone (515) 309-6011

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231206001586 SC Practitioner - Certified Nurse Midwife (CNM) 2769422864 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
Georgetown Physician Associates LLC CurrentSince Oct 1, 2023 Accepting new patients
Georgetown Physician Associates, LLC Current Accepting new patients
Georgetown Physician Associates, LLC CurrentSince Oct 1, 2023 Accepting new patients
Charleston Midwife Services Past Accepting new patients

Locations

606 Black River Rd
Ste 300
Georgetown, SC 29440
Phone (843) 527-4343

2347 S Highway 17
Murrells Inlet, SC 29576
Phone (843) 357-2443

12117 Ocean Hwy
Pawleys Island, SC 29585
Phone (843) 237-8231

Interoperability endpoints

  • Direct secure messaging: kjohansen447842@direct.musc.edu

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1139875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619654400000",
    "number": "1104890698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 50095",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981455095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1959 NE PACIFIC ST.",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981950001",
            "telephone_number": "206-520-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1440 Pleasant St",
            "address_2": "Suite 1",
            "address_purpose": "LOCATION",
            "city": "Des Moines",
            "state": "IA",
            "postal_code": "503141728",
            "country_code": "US",
            "telephone_number": "515-309-6011",
            "fax_number": "515-309-6014",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIGHT JOHANSEN",
        "first_name": "KIMBERLY",
        "middle_name": "A",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-14",
        "last_updated": "2021-04-29",
        "certification_date": "2021-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "WA",
            "license": "AP60305993",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.