Kimberly Ann Johnson, CNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

1510 Issued in MN

Practice address

4899 Miller Trunk Hwy Ste 208
Hermantown, MN 55811-1582

Phone

(218) 727-3888

Fax

(218) 260-4772

NPI assigned

Aug 4, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Kimberly Bakka Former name

Medicare fee-for-service enrollment

Enrolled in MN

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

Specialty

Nurse Practitioner

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Northern Waters ClinicGroup PAC ID 1355816182, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.qualifacts.org/api/fhir/humandevelopmentcenter/r4/

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.

• Northern Waters Clinic

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Hermantown, MN
  • NPI 1316445455
  Medicare reassignment Care Compare group NPD
• Brightwater Health Dba Human Development Center

  • Community/Behavioral Health Agency
  • Cloquet, MN
  • NPI 1114048527
  NPD (past)
• Brightwater Health Dba Human Development Center

  dba Human Development Center

  • Community/Behavioral Health Agency
  • Superior, WI
  • NPI 1407021579
  NPD (past)

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

{
    "created_epoch": "1312416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584403200000",
    "number": "1295014520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4899 MILLER TRUNK HWY STE 208",
            "city": "HERMANTOWN",
            "state": "MN",
            "postal_code": "558111582",
            "telephone_number": "218-727-3888",
            "fax_number": "218-260-4772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4899 MILLER TRUNK HWY STE 208",
            "city": "HERMANTOWN",
            "state": "MN",
            "postal_code": "558111582",
            "telephone_number": "218-727-3888",
            "fax_number": "218-260-4772"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "40 11th St",
            "address_purpose": "LOCATION",
            "city": "Cloquet",
            "state": "MN",
            "postal_code": "557201817",
            "country_code": "US",
            "telephone_number": "218-879-4559",
            "fax_number": "218-879-0282",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "40 11th St",
            "address_purpose": "LOCATION",
            "city": "Cloquet",
            "state": "MN",
            "postal_code": "557201817",
            "country_code": "US",
            "telephone_number": "218-879-4559",
            "fax_number": "218-879-0282",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4897 Miller Trunk Hwy Ste 208",
            "address_purpose": "LOCATION",
            "city": "Hermantown",
            "state": "MN",
            "postal_code": "558111697",
            "country_code": "US",
            "telephone_number": "218-727-3888",
            "fax_number": "218-260-4772",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KIMBERLY",
        "middle_name": "ANN",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-04",
        "last_updated": "2020-03-17",
        "certification_date": "2020-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MN",
            "license": "1510",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1295014520",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1295014520",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "BAKKA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jessica Podpeskar
• Abby Pershke Johnson, DDS
• Emily Jean Johnson
• Kaia Mae Johnson, BS
• Katlen Marie Johnson
• Robert Franklyn Johnson, PHARMD, RPH
• Madelyn Grace Jouppi
• Chelsae Ann Kalm
• Ty Karnes, PTA
• Megan A Karschnik, PA-C

• Psychiatric/Mental Health Nurse Practitioner in Hermantown, MN
• Providers in Hermantown, MN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2020; 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.

Verify at the official NPI Registry.