Individual provider Active NPI

Jennifer Johnson, NP

  • Nurse Practitioner
  • Aurora, CO
National Provider Identifier
1255843504
Registry record updated Dec 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
APN.0996560-NP Issued in CO
Practice address
3292 Peoria St
Aurora, CO 80010-1517
Phone
(303) 360-6276
Fax
(303) 789-7222
NPI assigned
Oct 26, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN2310544 MA
Nurse Practitioner 363L00000X APN.0996560-NP CO Primary

Addresses

Primary practice location

3292 Peoria St
Aurora, CO 80010-1517

Mailing address

2255 S Oneida St
Denver, CO 80224-2522
Phone (303) 761-1977

Other identifiers 1

IdentifierTypeStateIssuer
9000206364MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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

Enrollment IDStateProvider typePAC IDDetails
I20230123001643 CO Practitioner - Nurse Practitioner 5496015935 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APN.0996560-NPCOMDNurse Practitioner
RN2310544MAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Metro Community Provider Network Inc Current Accepting new patients
Metro Community Provider Network, Inc. CurrentSince Oct 11, 2022 Accepting new patients
Metro Community Provider Network Inc CurrentSince Oct 11, 2022 Accepting new patients
Metro Community Provider Network Inc Past Accepting new patients

Locations

3292 Peoria St
Aurora, CO 80010
Phone (303) 343-6130

2255 S Oneida St
Denver, CO 80224

17866 Cottonwood Dr
Parker, CO 80134
Phone (303) 205-6899

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1508976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670284800000",
    "number": "1255843504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2255 S ONEIDA ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802242522",
            "telephone_number": "303-761-1977",
            "fax_number": "303-343-0247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3292 PEORIA ST",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800101517",
            "telephone_number": "303-360-6276",
            "fax_number": "303-789-7222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JENNIFER",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-26",
        "last_updated": "2022-12-06",
        "certification_date": "2022-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MA",
            "license": "RN2310544",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CO",
            "license": "APN.0996560-NP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000206364",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Aurora, CO

Sources for this page

Verify at the official NPI Registry.