Active NPI
Jessica L Johnson
- Nurse Practitioner
- Rolla, MO
National Provider Identifier
1174449128
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 2026028820
- Practice address
- 603 S Bishop Ave
Rolla, MO 65401-4320 - Phone
- (573) 426-4411
- Fax
- (573) 426-4403
- NPI assigned
- Jun 25, 2026
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 2026028820 | MO | Primary |
Addresses
Primary practice location
603 S Bishop Ave
Rolla, MO 65401-4320
Mailing address
1050 W 10TH St
Rolla, MO 65401-2905
Phone (573) 364-9000
Other practice location 1
1000 Gw Ln
Waynesville, MO 65583-2339
Phone (573) 842-4116
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2026
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1050 W 10TH St
Rolla, MO 65401-2905
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1782345600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1174449128",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1050 W 10TH ST",
"city": "ROLLA",
"state": "MO",
"postal_code": "654012905",
"telephone_number": "573-364-9000",
"fax_number": "573-426-2108"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "603 S BISHOP AVE",
"city": "ROLLA",
"state": "MO",
"postal_code": "654014320",
"telephone_number": "573-426-4411",
"fax_number": "573-426-4403"
}
],
"practiceLocations": [
{
"address_1": "1000 Gw Ln",
"address_purpose": "LOCATION",
"city": "Waynesville",
"state": "MO",
"postal_code": "655832339",
"country_code": "US",
"telephone_number": "573-842-4116",
"fax_number": "573-433-2008",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JOHNSON",
"first_name": "JESSICA",
"middle_name": "L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-06-25",
"last_updated": "2026-07-13",
"certification_date": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MO",
"license": "2026028820",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rolla, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.