Roberta Johnson

Primary specialty

Phlebotomy TechnicianTaxonomy code 246RP1900X

Practice address

1624 Boismenue Ave
Centreville, IL 62207-2131

Phone

(618) 698-3308

NPI assigned

Nov 19, 2021

Last updated

Nov 19, 2021By 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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1637280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637280000000",
    "number": "1366109845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1624 BOISMENUE AVE",
            "city": "CENTREVILLE",
            "state": "IL",
            "postal_code": "622072131",
            "telephone_number": "618-698-3308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1624 BOISMENUE AVE",
            "city": "CENTREVILLE",
            "state": "IL",
            "postal_code": "622072131",
            "telephone_number": "618-698-3308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "ROBERTA",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-11-19",
        "last_updated": "2021-11-19",
        "certification_date": "2021-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246RP1900X",
            "taxonomy_group": "",
            "desc": "Technician, Pathology, Phlebotomy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Na",
            "affiliation": "N",
            "endpointDescription": "Na",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Na",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Na",
            "address_1": "1624 Boismenue Ave",
            "city": "Centreville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622072131",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Porshia Lenee' Egerson, LMT
• Kalyani Gavini, M.D.
• Michelle Gaydenhopkins
• Vandana Gupta, D.D.S
• Ameanna Vusu Hamilton
• Laura Anne Lengyel, MA, LCPC, ATR-BC
• Justine Ann Livesay, LCPC
• Heather L Lucas-Foster, M.D.
• David Reed Lysakowski, LCSW
• Alecia E Marks, LCSW

• Phlebotomy Technician in Centreville, IL
• Providers in Centreville, IL by specialty
• Phlebotomy Technician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2021; 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.