Jacob Wayne Johns

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

236439 Issued in AZ

Practice address

2728 N 24TH St
Phoenix, AZ 85008-1050

Phone

(844) 646-3247

NPI assigned

Jan 13, 2020

Last updated

Nov 17, 2021By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in AZ

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, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mind 247 Practice LLCGroup PAC ID 6406253541, 33 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mind 247 Practice LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Phoenix, AZ
  • NPI 1902472467
  Medicare reassignment Care Compare group NPD
• Mind 247 Practice LLC

  • Psychiatry Physician
  • Mesa, AZ
  • NPI 1659089951
  NPD
• Mind 247 Practice LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Mesa, AZ
  • NPI 1750058244
  NPD
• Recovia LLC

  • Addiction (Substance Use Disorder) Counselor
  • Phoenix, AZ
  • NPI 1386313864

  Psychiatric/Mental Health

  NPD (past)
• Recovia LLC

  • Addiction (Substance Use Disorder) Psychologist
  • Phoenix, AZ
  • NPI 1568139616
  NPD (past)

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

{
    "created_epoch": "1578873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637107200000",
    "number": "1235779737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2728 N 24TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850081050",
            "telephone_number": "844-646-3247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2728 N 24TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850081050",
            "telephone_number": "844-646-3247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNS",
        "first_name": "JACOB",
        "middle_name": "WAYNE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-01-13",
        "last_updated": "2021-11-17",
        "certification_date": "2021-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "236439",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacqueline R. John, MSW
• Pheba John, PHARM D.
• Ruby John
• Tara John, RDN
• Gregory J Johns, M.D.
• Prince Johns
• Santana Johns
• Stanley Johnsen, M.D.
• Steen Johnsen, MD
• Briannah Laquay Johnson Jewel, RN

• Psychiatric/Mental Health Nurse Practitioner in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Psychiatric/Mental Health Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2021; 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.