Individual provider Active NPI

Johnny Edward Liner, NP

  • Primary Care Nurse Practitioner
  • Spokane Valley, WA
National Provider Identifier
1124685045
Registry record updated Jun 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
AP60930259 Issued in WA
Practice address
16201 E Indiana Ave Ste 3260
Spokane Valley, WA 99216-2846
Phone
(509) 495-1810
Fax
(509) 505-0806
NPI assigned
May 27, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X AP141227 TX
Primary Care Nurse Practitioner 363LP2300X 65670 ID
Primary Care Nurse Practitioner 363LP2300X AP60930259 WA Primary

Addresses

Primary practice location

16201 E Indiana Ave Ste 3260
Spokane Valley, WA 99216-2846

Mailing address

522 W Riverside Ave Ste 4115
Spokane, WA 99201-0580
Phone (509) 495-1810

Other practice location 1

505 E Foothills Dr
Spokane, WA 99207-2101
Phone (509) 838-4651

Other practice location 2

1401 N Calispel St
Spokane, WA 99201-2317
Phone (509) 838-4651

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, TX2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190624003451 WA Practitioner - Nurse Practitioner 3173857208 Reassigns benefits to 2 organizations
I20211216000960 TX Practitioner - Nurse Practitioner 3173857208 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Spokane Behavioral Health LLCGroup PAC ID 2961757489, 24 clinicians

Practice addresses (Care Compare)

104 W 5TH Ave
Spokane, WA 99204-4820
Phone (623) 670-0840

104 W 5TH Ave
Attn Cfo
Spokane, WA 99204-4880

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
65670IDMDPrimary Care Nurse Practitioner
AP141227TXMDPrimary Care Nurse Practitioner
AP60930259WAMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Atticus Health, PLLC CurrentSince May 1, 2021 Accepting new patients
Spokane Behavioral Health LLC CurrentSince Feb 26, 2024 Accepting new patients
Cerebral Medical Group, a Professional Corporation CurrentSince Sep 13, 2021 Accepting new patients
Frontier Behavioral Health CurrentSince Mar 1, 2021 Accepting new patients

Locations

340 S Lemon Ave
Ste 9892
Walnut, CA 91789
Phone (415) 617-9894

104 W 5th Ave
Spokane, WA 99204
Phone (509) 992-1888

505 E North Foothills Dr
Spokane, WA 99207
Phone (509) 325-5502

1401 N Calispel St
Spokane, WA 99201
Phone (406) 740-2150

107 S Division St
Spokane, WA 99202
Phone (509) 383-4651

522 W Riverside Ave
Ste 4115
Spokane, WA 99201

506 N Sullivan Rd
Ste F227
Spokane Valley, WA 99037

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": "1558915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685664000000",
    "number": "1124685045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "522 W RIVERSIDE AVE STE 4115",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992010580",
            "telephone_number": "509-495-1810",
            "fax_number": "509-505-0806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16201 E INDIANA AVE STE 3260",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992162846",
            "telephone_number": "509-495-1810",
            "fax_number": "509-505-0806"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "505 E Foothills Dr",
            "address_purpose": "LOCATION",
            "city": "Spokane",
            "state": "WA",
            "postal_code": "992072101",
            "country_code": "US",
            "telephone_number": "509-838-4651",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1401 N Calispel St",
            "address_purpose": "LOCATION",
            "city": "Spokane",
            "state": "WA",
            "postal_code": "992012317",
            "country_code": "US",
            "telephone_number": "509-838-4651",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LINER",
        "first_name": "JOHNNY",
        "middle_name": "EDWARD",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-27",
        "last_updated": "2023-06-02",
        "certification_date": "2023-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "TX",
            "license": "AP141227",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "ID",
            "license": "65670",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "WA",
            "license": "AP60930259",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane Valley, WA

Sources for this page

Verify at the official NPI Registry.