Roger Dale Johnson, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

TN11991 Issued in TN

Practice address

207 E Myrtle Ave
Johnson City, TN 37601-4633

Phone

(423) 925-2600

Fax

(423) 925-2600

NPI assigned

Jun 2, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209513600000",
    "number": "1215975362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "252 WORTHINGTON DR",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376633180",
            "telephone_number": "423-925-2600",
            "fax_number": "423-925-2600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 E MYRTLE AVE",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376014633",
            "telephone_number": "423-925-2600",
            "fax_number": "423-925-2600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "ROGER",
        "middle_name": "DALE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-02",
        "last_updated": "2008-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "TN11991",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3643768",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Leigh Johnson, M.D.
• Marie A Johnson, CCC-SLP
• Michael D Johnson, PA
• Michelle Eileen Johnson, M.S., R.D., LDN
• Phung Pham Johnson, DMD
• Ruth D Johnson, MSN
• Victoria White Johnson, PA-C
• Brian David Johnston, ATC, OTC
• Chambless Rand Johnston III, MD
• Emmalea Elizabeth Johnston, NP-C

• Family Nurse Practitioner in Johnson City, TN
• Providers in Johnson City, 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 Apr 30, 2008; 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.