Mandi Jo Johnson, FNP-BC
Individual provider Active NPI Family Nurse Practitioner · Grantsville, WV
NPI 1184090920 · NPPES record last updated Aug 22, 2018
Key facts
- NPI
- 1184090920
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 75549 (WV)
- Practice address
- 186 Hospital Dr
Grantsville, WV 26147 - Phone
- (304) 354-9244
- Fax
- (304) 354-5963
- NPI assigned
- Aug 17, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 8
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Minnie Hamilton Health Care Center Inc
Practice addresses (Care Compare)
186 Hospital Dr
Grantsville, WV 26147-7100
Phone 30435492441130
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WV
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160216002572 | WV | Practitioner - Nurse Practitioner | 9133424989 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 75549 | WV | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Minnie Hamilton Health Care Center, Inc. | Current |
Accepting new patients | |
| Minnie Hamilton Health Care Center, Inc. | Current |
Accepting new patients | |
| Minnie Hamilton Health Care Center, Inc. | Past | Accepting new patients | |
| Minnie Hamilton Health Care Center Inc | Past | Accepting new patients | |
| Minnie Hamilton Health Care Center, Inc. | Past | Accepting new patients |
Locations
921 Mineral Rd
Ste 101
Glenville, WV 26351
Phone (304) 462-7322
186 Hospital Dr
Grantsville, WV 26147
Phone (304) 354-9244
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 75549 | WV | Yes |
Addresses
Primary practice location
186 Hospital Dr
Grantsville, WV 26147
Mailing address
186 Hospital Dr
Grantsville, WV 26147-7100
Phone (304) 354-9244
Other providers in Grantsville, WV
- Sheri Lynn Honaker
- Garnet J. Husk
- Roshan Ally Hussain
- J&B Pharmacy1St LLC
- Jessica Leann Jett
- Cathy S. Jones
- Debbie Rexroad Jones
- Megan Paige Jones
- Amy Michele King
- Janie Lee Knotts
All providers in Grantsville, WV · Family Nurse Practitioner in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.