Jamie Vaughn Johnson

Key facts

NPI

1407584733

Entity type

Individual (NPI type 1)

Primary specialty

Technician 374700000X

Practice address

509 E Byron Nelson Blvd Ste C
Roanoke, TX 76262-6183

Phone

(214) 326-5721

NPI assigned

Aug 14, 2022

Sex

Female

Sole proprietor

Yes

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 and National Provider Directory roles.

• Olysis, LLC Medical Specialty Clinic/Center · Roanoke, TX · NPI 1841078946
  NPD Authorized official

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Practice roles

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 15, 2025.

{
    "created_epoch": "1660435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741996800000",
    "number": "1407584733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4213 ROUND VALLEY LANE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76262",
            "telephone_number": "214-326-5721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 E BYRON NELSON BLVD STE C",
            "city": "ROANOKE",
            "state": "TX",
            "postal_code": "762626183",
            "telephone_number": "214-326-5721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JAMIE",
        "middle_name": "VAUGHN",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-08-14",
        "last_updated": "2025-03-15",
        "certification_date": "2025-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "374700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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