Nicole Lee Johnson, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

043120707 Issued in IL

Practice address

11531 Sunderland Rd
Marion, IL 62959-8274

Phone

(618) 201-9907

NPI assigned

Jan 25, 2019

Last updated

Jan 25, 2019By the provider in NPPES

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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1548374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548374400000",
    "number": "1336603109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4713 ELKVILLE RD",
            "city": "VERGENNES",
            "state": "IL",
            "postal_code": "629941805",
            "telephone_number": "618-201-9907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11531 SUNDERLAND RD",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629598274",
            "telephone_number": "618-201-9907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "NICOLE",
        "middle_name": "LEE",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-01-25",
        "last_updated": "2019-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "IL",
            "license": "043120707",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAXONOMY CODE",
            "identifier": "164W00000X",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRIVERS LICENSE",
            "identifier": "J52563291734",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brandi Johns, REGISTERED NURSE
• Adam Webster Johnson, PTA
• Alia Nicole Johnson, RN
• Katie Johnson, LCSW
• Marcus Timmie Darnell Johnson, BA
• Bailey Johnston, NP
• Charles Thomas Johnston Jr., CSFA
• Jennifer Nicole Johnston, PHARM. D.
• Abigail Jones
• Alexis Jones, PHARM.D.

• Licensed Practical Nurse in Marion, IL
• Providers in Marion, IL by specialty
• Licensed Practical Nurse in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.