Joanna Kristine Affolter

Primary specialty

Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0808X

License

95053961 Issued in CA

Practice address

1904 Richland Ave
Ceres, CA 95307-4562

Phone

(209) 300-8800

NPI assigned

May 6, 2019

Last updated

May 6, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Joanna Kristine Clemens Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1557100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557100800000",
    "number": "1124683008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24240 AWAHANEE RD",
            "city": "SONORA",
            "state": "CA",
            "postal_code": "953708333",
            "telephone_number": "209-694-6004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1904 RICHLAND AVE",
            "city": "CERES",
            "state": "CA",
            "postal_code": "953074562",
            "telephone_number": "209-300-8800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AFFOLTER",
        "first_name": "JOANNA",
        "middle_name": "KRISTINE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-05-06",
        "last_updated": "2019-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95053961",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGISTERED NURSE",
            "identifier": "95053961",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JOANNA",
            "last_name": "CLEMENS",
            "middle_name": "KRISTINE",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• David Emmett Abeyta, AMFT
• Rachel Ann Acosta, LMFT
• Aegis Treatment Centers, LLC
• Juan Aguilar
• Viviana Aguilera
• John P Aguirre
• Mary Aguirre
• Nathaniel Timothy Aguirre

• Psychiatric/Mental Health Registered Nurse in Ceres, CA
• Providers in Ceres, CA by specialty
• Psychiatric/Mental Health Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.