Active NPI
Angela Jane Johnson, PHLEB/VENI,HOMEHEALT
- Home Health Agency
- Jackson, TN
National Provider Identifier
1194336628
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- Practice address
- 24 Revere Cir Apt 13
Jackson, TN 38305-3468 - Phone
- (731) 513-0975
- NPI assigned
- Aug 10, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 12
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Religious Nonmedical Practitioner | 374K00000X | |||
| Home Health Agency | 251E00000X | Primary | ||
| Rehabilitation Practitioner | 225400000X | |||
| Home Infusion Agency | 251F00000X | |||
| In Home Supportive Care Agency | 253Z00000X | |||
| Non-emergency Medical Transport (VAN) | 343900000X | |||
| Nutritionist | 133N00000X | |||
| Personal Emergency Response Attendant | 146D00000X | |||
| Phlebology Physician | 202K00000X | JMCGHISSUED | TN | |
| Driver | 172A00000X | |||
| Legal Medicine | 173000000X | |||
| Meals Provider | 174200000X |
Addresses
Primary practice location
24 Revere Cir Apt 13
Jackson, TN 38305-3468
Mailing address
24 Revere Cir Apt 13
Jackson, TN 38305-3468
Phone (731) 513-0975
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| JMCGHISSUED | TN | MD | Phlebology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597017600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597017600000",
"number": "1194336628",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24 REVERE CIR APT 13",
"city": "JACKSON",
"state": "TN",
"postal_code": "383053468",
"telephone_number": "731-513-0975"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24 REVERE CIR APT 13",
"city": "JACKSON",
"state": "TN",
"postal_code": "383053468",
"telephone_number": "731-513-0975"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "ANGELA",
"middle_name": "JANE",
"credential": "PHLEB/VENI,HOMEHEALT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-08-10",
"last_updated": "2020-08-10",
"certification_date": "2020-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "374K00000X",
"taxonomy_group": "",
"desc": "Religious Nonmedical Practitioner",
"state": null,
"license": null,
"primary": false
},
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": null,
"license": null,
"primary": true
},
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": null,
"license": null,
"primary": false
},
{
"code": "251F00000X",
"taxonomy_group": "",
"desc": "Home Infusion",
"state": null,
"license": null,
"primary": false
},
{
"code": "253Z00000X",
"taxonomy_group": "",
"desc": "In Home Supportive Care",
"state": null,
"license": null,
"primary": false
},
{
"code": "343900000X",
"taxonomy_group": "",
"desc": "Non-emergency Medical Transport (VAN)",
"state": null,
"license": null,
"primary": false
},
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": null,
"license": null,
"primary": false
},
{
"code": "146D00000X",
"taxonomy_group": "",
"desc": "Personal Emergency Response Attendant",
"state": null,
"license": null,
"primary": false
},
{
"code": "202K00000X",
"taxonomy_group": "",
"desc": "Phlebology",
"state": "TN",
"license": "JMCGHISSUED",
"primary": false
},
{
"code": "172A00000X",
"taxonomy_group": "",
"desc": "Driver",
"state": null,
"license": null,
"primary": false
},
{
"code": "173000000X",
"taxonomy_group": "",
"desc": "Legal Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "174200000X",
"taxonomy_group": "",
"desc": "Meals",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Jackson, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.