Individual provider Active NPI

Nicole Lee Johnson, FNP

  • Family Nurse Practitioner
  • Liverpool, NY
National Provider Identifier
1285205344
Registry record updated Jul 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
347749 Issued in NY
Practice address
7375 Oswego Rd
Liverpool, NY 13090-3717
Phone
(315) 291-0064
NPI assigned
Jul 8, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 347749 NY Primary

Addresses

Primary practice location

7375 Oswego Rd
Liverpool, NY 13090-3717

Mailing address

8581 Cobalt Dr
Cicero, NY 13039-8977
Phone (607) 207-2372

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20210730002187 NY Practitioner - Nurse Practitioner 0749683506 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
347749NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Geriatric & Palliative Specialist PC CurrentSince Dec 14, 2025 Accepting new patients
Wellnow Urgent Care, PC CurrentSince Aug 1, 2021 Accepting new patients

Locations

446 Fairview Ave
Ste 200
Hudson, NY 12534
Phone (518) 267-3496

7375 Oswego Rd
#1
Liverpool, NY 13090
Phone (315) 291-0064

101 W Utica St
Ste C
Oswego, NY 13126
Phone (315) 216-4641

Organizations & group practices 2

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": "1625702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625702400000",
    "number": "1285205344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8581 COBALT DR",
            "city": "CICERO",
            "state": "NY",
            "postal_code": "130398977",
            "telephone_number": "607-207-2372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7375 OSWEGO RD",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130903717",
            "telephone_number": "315-291-0064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "NICOLE",
        "middle_name": "LEE",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-08",
        "last_updated": "2021-07-08",
        "certification_date": "2021-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "347749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Liverpool, NY

Sources for this page

Verify at the official NPI Registry.