Katie Alyse Johnson, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

25622 Issued in TN

Practice address

587 Skyline Dr
Jackson, TN 38301-3938

Phone

(731) 424-8922

Fax

(731) 423-2922

NPI assigned

Mar 25, 2019

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

Medicare fee-for-service enrollment

Enrolled in TN

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

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Total Extended Care Services PCGroup PAC ID 9133029127, 29 clinicians

Christian Family Medicine, LLCGroup PAC ID 7315903978, 33 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Christian Family Medicine, LLC

  • Family Medicine Physician
  • Ripley, TN
  • NPI 1043252620
  Medicare reassignment Care Compare group NPD
• Total Extended Care Services PC

  • Physical Medicine & Rehabilitation Physician
  • Englewood, OH
  • NPI 1699522029

  TN

  Medicare reassignment Care Compare group NPD (past)
• West Tennessee Medical Group Inc

  • Internal Medicine Physician
  • Jackson, TN
  • NPI 1053615955
  NPD (past)
• Tecs Utah PC

  • Physical Medicine & Rehabilitation Physician
  • American Fork, UT
  • NPI 1831985951
  NPD (past)

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

{
    "created_epoch": "1553472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553472000000",
    "number": "1194285189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1804 HIGHWAY 45 BYP STE 604",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383054403",
            "telephone_number": "731-660-7971",
            "fax_number": "731-660-8739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "587 SKYLINE DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013938",
            "telephone_number": "731-424-8922",
            "fax_number": "731-423-2922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KATIE",
        "middle_name": "ALYSE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-25",
        "last_updated": "2019-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "25622",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Corey Lee Johnson
• Doretha Johnson, LMSW
• Jeffrey Johnson, SLP
• Jesse Johnson, LPC/MHSP
• Justice B Johnson, DMD
• Keli Johnson, CLINICIAN
• Kristi Rene Johnson, RN
• Krystle Elizabeth Amelia Johnson
• L David Johnson, MD
• Monifa Johnson

• Family Nurse Practitioner in Jackson, TN
• Providers in Jackson, TN by specialty
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2019; 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.

Verify at the official NPI Registry.