Individual provider Active NPI

Micah Gelani Johnson

  • Student in an Organized Health Care Education/Training Program
  • Oshkosh, WI
National Provider Identifier
1144194739
Registry record updated Oct 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
License
264928-30 Issued in WI
Practice address
800 Algoma Blvd
Oshkosh, WI 54901-3551
Phone
(920) 424-1234
NPI assigned
Oct 6, 2025
Last updated
Oct 6, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 6, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 264928-30 WI Primary

Addresses

Primary practice location

800 Algoma Blvd
Oshkosh, WI 54901-3551

Mailing address

6408 Bridge Rd Apt 242
Monona, WI 53713-1832
Phone (908) 229-8633

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

LicenseStateTypeSpecialty
264928-30WIMDStudent in an Organized Health Care Education/Training Program

NPI Registry JSON

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

{
    "created_epoch": "1759708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759708800000",
    "number": "1144194739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6408 BRIDGE RD APT 242",
            "city": "MONONA",
            "state": "WI",
            "postal_code": "537131832",
            "telephone_number": "908-229-8633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 ALGOMA BLVD",
            "city": "OSHKOSH",
            "state": "WI",
            "postal_code": "549013551",
            "telephone_number": "920-424-1234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MICAH",
        "middle_name": "GELANI",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-10-06",
        "last_updated": "2025-10-06",
        "certification_date": "2025-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "WI",
            "license": "264928-30",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oshkosh, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 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.

Verify at the official NPI Registry.