Jennifer Lynn Johnson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0110004411 Issued in VA

Practice address

5060 Valley View Blvd NW
Roanoke, VA 24012-2038

Phone

(540) 278-1051

Fax

(540) 278-1052

NPI assigned

Mar 3, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jjohnson62382@direct.carilionclinic.org

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.

• Carilion Healthcare Corporation

  • Multi-Specialty Clinic/Center
  • Roanoke, VA
  • NPI 1447206370
  NPD (past)

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

{
    "created_epoch": "1330732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626307200000",
    "number": "1205100583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5060 VALLEY VIEW BLVD NW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240122038",
            "telephone_number": "540-278-1051",
            "fax_number": "540-278-1052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5060 VALLEY VIEW BLVD NW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240122038",
            "telephone_number": "540-278-1051",
            "fax_number": "540-278-1052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JENNIFER",
        "middle_name": "LYNN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-03",
        "last_updated": "2021-07-15",
        "certification_date": "2021-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WV",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110004411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jjohnson62382@direct.carilionclinic.org",
            "affiliation": "N",
            "endpointDescription": "jjohnson62382@direct.carilionclinic.org",
            "address_1": "101 Elm Ave SE",
            "city": "Roanoke",
            "state": "VA",
            "country_code": "US",
            "postal_code": "240132222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Emily Brooke Johnson, PHARMD
• Emily Marie Johnson, M.S., CCC-SLP
• Emily Rebecca Johnson, FNP-C
• Evan Mitchell Johnson, DMD, MS
• Isaiah Micah Johnson, M.D.
• Karen Leigh Johnson, LPC
• Kathryn Quinn Johnson, D.O.
• Kinsey Mariah Johnson, OTR/L
• Lauren Kay Johnson, PA-C
• Loren Johnson, MA, LPC, LMHC, LPCC

• Physician Assistant in Roanoke, VA
• Providers in Roanoke, VA by specialty
• Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.