Active NPI
Johanna Catherine McKenna, CRNP
- Family Nurse Practitioner
- Lebanon, NH
National Provider Identifier
1265049324
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 111369-23
- Practice address
- 18 Old Etna Rd
Lebanon, NH 03766-1970 - Phone
- (603) 650-5000
- Fax
- (603) 640-1228
- NPI assigned
- Sep 23, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | R220471 | MD | |
| Family Nurse Practitioner | 363LF0000X | 111369-23 | NH | Primary |
Addresses
Primary practice location
18 Old Etna Rd
Lebanon, NH 03766-1970
Mailing address
2802 Urbana Dr
Silver Spring, MD 20906-5033
Phone (603) 630-4454
Other practice location 1
10750 Columbia Pike Ste 320
Silver Spring, MD 20901-4453
Phone (603) 630-4454
Other practice location 2
317 E Diamond Ave Ste C
Gaithersburg, MD 20877-5327
Phone (240) 246-1111
Other names 1
- Johanna Catherine Lake
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC, MD, NH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 3
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- George Washington University School of Medicine, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
18 Old Etna Rd
Lebanon, NH 03766-1937
Phone (603) 650-4000
Hospital & facility affiliations
- Vna and Hospice of Vermont and New Hampshire
- Mary Hitchcock Memorial Hospital
- Alice Peck Day Memorial Hospital
- New London Hospital
- Mt Ascutney Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 111369-23 | NH | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mary Hitchcock Memorial Hospital | Current | Accepting new patients | |
| Capital Healthcare PC | Current | Accepting new patients | |
| Mary Hitchcock Memorial Hospital | Current | Accepting new patients | |
| Dartmouth-Hitchcock Clinic | Current | Accepting new patients | |
| Dartmouth-Hitchcock Clinic | Current | Accepting new patients |
Locations
8205 Snowden River Pkwy
Columbia, MD 21045
Phone (410) 290-9990
1 Medical Dr
Lebanon, NH 03756
Phone (603) 650-5922
18 Old Etna Rd
Lebanon, NH 03766
Phone (603) 650-3100
6020 Richmond Hwy
Ste 102
Alexandria, VA 22303
Phone (267) 978-1993
Organizations & group practices 5
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.
-
- General Acute Care Hospital
- Lebanon, NH
- NPI 1023092053
-
- Internal Medicine Physician
- Lebanon, NH
- NPI 1548210198
-
- Substance Use Disorder Rehabilitation Clinic/Center
- Keene, NH
- NPI 1174176861
-
- Psychiatric Hospital
- Hampstead, NH
- NPI 1699584219
Hospital & facility affiliations 14
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Critical Access Hospital
- Lebanon, NH
- NPI 1003803495
-
- Obstetrics & Gynecology Physician
- Lebanon, NH
- NPI 1093761892
Hospital
-
- General Acute Care Hospital
- Lebanon, NH
- NPI 1023092053
-
- General Acute Care Hospital
- Lebanon, NH
- NPI 1629788237
-
- Critical Access Hospital
- New London, NH
- NPI 1831200583
-
- Home Health Agency
- White River Junction, VT
- NPI 1063494698
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1600819200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1765756800000",
"number": "1265049324",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2802 URBANA DR",
"city": "SILVER SPRING",
"state": "MD",
"postal_code": "209065033",
"telephone_number": "603-630-4454"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18 OLD ETNA RD",
"city": "LEBANON",
"state": "NH",
"postal_code": "037661970",
"telephone_number": "603-650-5000",
"fax_number": "603-640-1228"
}
],
"practiceLocations": [
{
"address_1": "10750 Columbia Pike Ste 320",
"address_purpose": "LOCATION",
"city": "Silver Spring",
"state": "MD",
"postal_code": "209014453",
"country_code": "US",
"telephone_number": "603-630-4454",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "317 E Diamond Ave Ste C",
"address_purpose": "LOCATION",
"city": "Gaithersburg",
"state": "MD",
"postal_code": "208775327",
"country_code": "US",
"telephone_number": "240-246-1111",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MCKENNA",
"first_name": "JOHANNA",
"middle_name": "CATHERINE",
"credential": "CRNP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-09-23",
"last_updated": "2025-12-15",
"certification_date": "2025-12-15",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MD",
"license": "R220471",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "NH",
"license": "111369-23",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JOHANNA",
"last_name": "LAKE",
"middle_name": "CATHERINE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Lebanon, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2025; 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.