Active NPI
Charlotte B. Johnson, CPNP
- Pediatric Nurse Practitioner
- Hildale, UT
National Provider Identifier
1124132733
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 186597-4405
- Practice address
- 1065 North Hildale St.
Hildale, UT 84784-0459 - Phone
- (436) 874-2217
- Fax
- (435) 874-7805
- NPI assigned
- Aug 19, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | RN101975 | AZ | |
| Pediatric Nurse Practitioner | 363LP0200X | 186597-4405 | UT | Primary |
Addresses
Primary practice location
1065 North Hildale St.
Hildale, UT 84784-0459
Mailing address
1065 North Hildale St.
Hildale, UT 84784-0459
Phone (436) 874-2217
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 197617 | Other | AZ | AHCCCS |
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
- Credentials
- Certified Pediatric Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN101975 | AZ | MD | Pediatric Nurse Practitioner |
| 186597-4405 | UT | MD | Pediatric Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1360022400000",
"number": "1124132733",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1065 NORTH HILDALE ST.",
"city": "HILDALE",
"state": "UT",
"postal_code": "847840459",
"telephone_number": "436-874-2217",
"fax_number": "435-874-7805"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1065 NORTH HILDALE ST.",
"city": "HILDALE",
"state": "UT",
"postal_code": "847840459",
"telephone_number": "436-874-2217",
"fax_number": "435-874-7805"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "CHARLOTTE",
"middle_name": "B.",
"credential": "CPNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-19",
"last_updated": "2013-02-05",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "AZ",
"license": "RN101975",
"primary": false
},
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "UT",
"license": "186597-4405",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AHCCCS",
"identifier": "197617",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hildale, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.