Peggy Deane Johnson, FNP-C
Individual provider Active NPI Family Nurse Practitioner · Cheyenne, WY
NPI 1245455286 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1245455286
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 9519.0206 (WY)
- Practice address
- 100 Central Ave
Cheyenne, WY 82007-1330 - Phone
- (307) 633-4040
- Fax
- (307) 633-4050
- NPI assigned
- Apr 16, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Memorial Hospital of Converse County
Practice addresses (Care Compare)
111 S 5TH St
Douglas, WY 82633-2434
Phone (307) 358-2122
1356 Shiek St
Wheatland, WY 82201-3231
Phone (307) 322-6408
700 E Ctr St
Douglas, WY 82633-2446
Phone (307) 358-7300
Hospital & facility affiliations
- Eden Home Health
- Memorial Hospital of Converse County
- Platte County Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20121011000537 | WY | Practitioner - Nurse Practitioner | 0143479923 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 206 | WY | MD | Addiction (Substance Use Disorder) Counselor |
| 9519.0206 | WY | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Memorial Hospital of Converse County | Current |
Accepting new patients | |
| Memorial Hospital of Converse County | Current |
Accepting new patients |
Locations
111 S 5th St
Douglas, WY 82633
Phone (307) 358-6200
111 S 5th St
Fl 4
Douglas, WY 82633
Phone (307) 358-6200
201 14th St
Wheatland, WY 82201
Phone (307) 322-3636
1356 Shiek St
Wheatland, WY 82201
Phone (307) 322-3861
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 9519.0206 | WY | Yes |
Addresses
Primary practice location
100 Central Ave
Cheyenne, WY 82007-1330
Mailing address
301 Park Ave
Wheatland, WY 82201-3323
Phone (307) 322-9896
NPI Registry JSON
{
"created_epoch": "1176681600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1245455286",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 PARK AVE",
"city": "WHEATLAND",
"state": "WY",
"postal_code": "822013323",
"telephone_number": "307-322-9896"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 CENTRAL AVE",
"city": "CHEYENNE",
"state": "WY",
"postal_code": "820071330",
"telephone_number": "307-633-4040",
"fax_number": "307-633-4050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "PEGGY",
"middle_name": "DEANE",
"name_prefix": "Mrs.",
"credential": "FNP-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "WY",
"license": "9519.0206",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cheyenne, WY
- Kimberly Johnson
- Laura Ellen Johnson
- Mera Geis Johnson
- Nicholas Robert Johnson
- Nicole Johnson
- Richard Johnson
- Robert Frank Johnson Sr.
- Roger Milborn Johnson
- Ryan James Johnson
- Tamieka Johnson
All providers in Cheyenne, WY · Family Nurse Practitioner in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.