Active NPI
Miranda Johnson, LMSW
- Social Worker
- Fayetteville, AR
National Provider Identifier
1306668595
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 11557-M
- Practice address
- 3822 N Parkview Dr
Fayetteville, AR 72703-6286 - Phone
- (479) 367-2866
- Fax
- (479) 332-5356
- NPI assigned
- Oct 29, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 11557-M | AR | Primary |
Addresses
Primary practice location
3822 N Parkview Dr
Fayetteville, AR 72703-6286
Mailing address
3822 N Parkview Dr
Fayetteville, AR 72703-6286
Phone (479) 367-2866
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11557-M | AR | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1730160000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730160000000",
"number": "1306668595",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3822 N PARKVIEW DR",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727036286",
"telephone_number": "479-367-2866",
"fax_number": "479-332-5356"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3822 N PARKVIEW DR",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727036286",
"telephone_number": "479-367-2866",
"fax_number": "479-332-5356"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "MIRANDA",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-10-29",
"last_updated": "2024-10-29",
"certification_date": "2024-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "AR",
"license": "11557-M",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.