Individual provider Active NPI

Kristen J Johnson, FNP

  • Nurse Practitioner
  • Savannah, GA
National Provider Identifier
1174787998
Registry record updated Aug 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN077029 Issued in GA
Practice address
4451 Paulsen St
Savannah, GA 31405
Phone
(912) 350-7500
Fax
(912) 350-7735
NPI assigned
Jul 10, 2008
Last updated
Aug 7, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN077029 GA
Nurse Practitioner 363L00000X RN077029 GA Primary

Addresses

Primary practice location

4451 Paulsen St
Savannah, GA 31405

Mailing address

4451 Paulsen St
Savannah, GA 31405
Phone (912) 350-7500

Other identifiers 3

IdentifierTypeStateIssuer
663055018BMedicaidGA
P00687387OtherGARAILROAD MEDICARE
663055018AMedicaidGA

Other names 1

  • Laura Kristen Jones Johnson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20090204000372 GA Practitioner - Nurse Practitioner 9739243890 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RN077029GAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
MPPG, Inc. CurrentSince Jan 1, 2009 Accepting new patients
MPPG, Inc. Nurse Practitioner Past Accepting new patients

Locations

3780 US Highway 17
Richmond Hill, GA 31324
Phone (912) 756-2292

4700 Waters Ave
#J
Savannah, GA 31404

4700 Waters Ave
Savannah, GA 31404
Phone (912) 273-1100

4451 Paulsen St
Savannah, GA 31405
Phone (912) 350-7500

1107 E 66th St
Savannah, GA 31404
Phone (912) 350-8404

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1215648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533600000000",
    "number": "1174787998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4451 PAULSEN ST",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "31405",
            "telephone_number": "912-350-7500",
            "fax_number": "912-350-7735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4451 PAULSEN ST",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "31405",
            "telephone_number": "912-350-7500",
            "fax_number": "912-350-7735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KRISTEN",
        "middle_name": "J",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-10",
        "last_updated": "2018-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN077029",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN077029",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "663055018B",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00687387",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "663055018A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAURA",
            "last_name": "JONES JOHNSON",
            "middle_name": "KRISTEN",
            "credential": "FNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Savannah, GA

Sources for this page

Verify at the official NPI Registry.