Raeanne Tatem Johnson, RN,MSN,CPNP-PC

Primary specialty

Developmental - Behavioral Pediatrics PhysicianTaxonomy code 2080P0006X

License

20227375 Issued in NC

Practice address

1005 Big Oak CT
Knightdale, NC 27545-6565

Phone

(919) 266-5669

Fax

(919) 488-1717

NPI assigned

Aug 19, 2014

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

Other names 1

• Ms. Raeanne Savage Tatem Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner, Registered Nurse

State licenses

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

{
    "created_epoch": "1408406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657497600000",
    "number": "1245639830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "260 HORIZON DR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276154922",
            "telephone_number": "919-488-0015",
            "fax_number": "919-277-0066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 BIG OAK CT",
            "city": "KNIGHTDALE",
            "state": "NC",
            "postal_code": "275456565",
            "telephone_number": "919-266-5669",
            "fax_number": "919-488-1717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "RAEANNE",
        "middle_name": "TATEM",
        "name_prefix": "Mrs.",
        "credential": "RN,MSN,CPNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-19",
        "last_updated": "2022-07-11",
        "certification_date": "2022-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NC",
            "license": "5007103",
            "primary": false
        },
        {
            "code": "2080P0006X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": "NC",
            "license": "20227375",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RAEANNE",
            "last_name": "TATEM",
            "middle_name": "SAVAGE",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kenneth E Jarmon Sr., DR
• Tyler James Jensen, MS, LCMHC, LMHC, NCC
• Marquita Renee Johnson Manneh, MSW, LCSW
• Jeffrey Lynn Johnson, PSYD
• Nyla Johnson
• Stephen E. Johnson, M.D.
• Patrice Nicole Jones, LPC
• Amos Jordan Jr.
• Sharmaine Raquel Joyner, MSW, LCSWA
• K. Jasinski, D.M.D., P.C.

• Developmental - Behavioral Pediatrics Physician in Knightdale, NC
• Providers in Knightdale, NC by specialty
• Developmental - Behavioral Pediatrics Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2022; 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.