Kailey Roberson Johnson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

328816 Issued in LA

Practice address

2508 Bert Kouns Industrial Loop Ste 310
Shreveport, LA 71118-3154

Phone

(318) 212-5880

NPI assigned

Sep 24, 2021

Sex

Female

Sole proprietor

Yes

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 LA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Interoperability endpoints

• Direct secure messaging: kroberson4@direct.wkhs.com

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.

• WK Pediatric Surgical Associates

  • Pediatric Surgery Physician
  • Shreveport, LA
  • NPI 1316386436
  Medicare reassignment

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

{
    "created_epoch": "1632441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732147200000",
    "number": "1275204745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6051 ROMA DR APT 508",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711054670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2508 BERT KOUNS INDUSTRIAL LOOP STE 310",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183154",
            "telephone_number": "318-212-5880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KAILEY",
        "middle_name": "ROBERSON",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-09-24",
        "last_updated": "2024-11-21",
        "certification_date": "2024-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "LA",
            "license": "328816",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jermaine Antonio Johnson, PMHNP-BC
• Jessica Johnson
• Jonathan Johnson, CRNA
• Joseph Johnson
• Joyce Guidry Johnson, BSN,RN
• Katoya Johnson
• Kayla Nicole Johnson
• Kennarius Johnson, MHS
• Kevlynn Johnson
• Kimberly Johnson, OCCUPATIONAL THERAPY

• Physician Assistant in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Physician Assistant in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.