Active NPI
Shirley K Johnson, CPNP, PNP
- Pediatric Nurse Practitioner
- Iowa City, IA
National Provider Identifier
1336129816
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- C077838
- Practice address
- 200 Hawkins Dr
Iowa City, IA 52242-1009 - Phone
- (319) 467-5384
- NPI assigned
- Jan 19, 2006
- Last updated
- Mar 17, 2018
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | R143918-8 | MN | |
| Pediatric Nurse Practitioner | 363LP0200X | C077838 | IA | Primary |
| Pediatrics Physician | 208000000X | R143918-8 | MN |
Addresses
Primary practice location
200 Hawkins Dr
Iowa City, IA 52242-1009
Mailing address
200 Hawkins Dr
Iowa City, IA 52242-1009
Phone (319) 467-5384
Other practice location 1
200 1st St SW
Rochester, MN 55905-0001
Phone (507) 284-2511
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500008374 | Other | MN | RAILROAD MEDICARE |
| ENROLLED | Medicaid | WI | |
| ENROLLED | Medicaid | IA | |
| 322100800 | Medicaid | MN |
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)
- Enrolled
- Credentials
- Certified Nurse Practitioner, Certified Pediatric Nurse Practitioner, Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R143918-8 | MN | MD | Nurse Practitioner |
| C077838 | IA | MD | Pediatric Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Floyd County Memorial Hospital Commission | Past | Accepting new patients |
Interoperability endpoints
- sjohnson125620@uihcdirect.org
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Critical Access Hospital
- Charles City, IA
- NPI 1265402390
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137628800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1336129816",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 HAWKINS DR",
"city": "IOWA CITY",
"state": "IA",
"postal_code": "522421009",
"telephone_number": "319-467-5384"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 HAWKINS DR",
"city": "IOWA CITY",
"state": "IA",
"postal_code": "522421009",
"telephone_number": "319-467-5384"
}
],
"practiceLocations": [
{
"address_1": "200 1st St SW",
"address_purpose": "LOCATION",
"city": "Rochester",
"state": "MN",
"postal_code": "559050001",
"country_code": "US",
"telephone_number": "507-284-2511",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JOHNSON",
"first_name": "SHIRLEY",
"middle_name": "K",
"credential": "CPNP, PNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-19",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MN",
"license": "R143918-8",
"primary": false
},
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "IA",
"license": "C077838",
"primary": true
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MN",
"license": "R143918-8",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "500008374",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "ENROLLED",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "ENROLLED",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "322100800",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Iowa City, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.