Kelly A Johnson, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

CNP101067 Issued in ME

Practice address

2 Great Falls PLZ Ste 21
Auburn, ME 04210-5966

Phone

(207) 330-3950

Fax

(207) 330-3955

NPI assigned

Sep 24, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kelly A Large Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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

{
    "created_epoch": "1285286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611705600000",
    "number": "1144539107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7291",
            "city": "LEWISTON",
            "state": "ME",
            "postal_code": "042437291",
            "telephone_number": "207-777-8950",
            "fax_number": "207-777-8800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 GREAT FALLS PLZ STE 21",
            "city": "AUBURN",
            "state": "ME",
            "postal_code": "042105966",
            "telephone_number": "207-330-3950",
            "fax_number": "207-330-3955"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "583 Lisbon St",
            "address_purpose": "LOCATION",
            "city": "Lisbon Falls",
            "state": "ME",
            "postal_code": "042521250",
            "country_code": "US",
            "telephone_number": "207-353-8830",
            "fax_number": "207-353-4836",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KELLY",
        "middle_name": "A",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-24",
        "last_updated": "2021-01-27",
        "certification_date": "2021-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ME",
            "license": "CNP101067",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kjohnson614932@direct-prd.goodhelpconnections.org",
            "affiliation": "N",
            "address_1": "2 Great Falls Plz Ste 21",
            "city": "Auburn",
            "state": "ME",
            "country_code": "US",
            "postal_code": "042105966",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "LARGE",
            "middle_name": "A",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Family Nurse Practitioner in Auburn, ME
• Providers in Auburn, ME by specialty
• Family Nurse Practitioner in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2021; 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.