Tanja Johnson, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

2014036364 Issued in MO

Practice address

11133 Dunn Rd
Saint Louis, MO 63136-6163

Phone

(314) 800-6528

NPI assigned

Oct 14, 2014

Last updated

Sep 16, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Provident IncGroup PAC ID 0345217279, 19 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Provident Inc.

  dba Provident Behavioral Health

  • Mental Health Counselor
  • Saint Louis, MO
  • NPI 1710023791
  Medicare reassignment Care Compare group NPD
• Southeastern Emergency Physicians of Memphis LLC

  • Emergency Medicine Physician
  • Alton, IL
  • NPI 1437105277

  MO, Nurse Practitioner

  Medicare reassignment NPD
• Southeastern Emergency Services of Memphis, P.C.

  • Emergency Medicine Physician
  • Chattanooga, TN
  • NPI 1164454450

  MO

  Medicare reassignment
• Bigeye Emergency Physicians LLC

  • Emergency Medicine Physician
  • Fulton, MO
  • NPI 1366829426
  NPD (past)
• Our Urgent Care, LLC

  • Urgent Care Clinic/Center
  • Maryland Heights, MO
  • NPI 1871819680
  NPD (past)
• Provident Inc

  dba Provident Behavioral Health

  • Mental Health Counselor
  • Saint Louis, MO
  • NPI 1043491020
  NPD (past)

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

{
    "created_epoch": "1413244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631750400000",
    "number": "1447654827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 MCCLUER CT",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633681503",
            "telephone_number": "314-800-6528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11133 DUNN RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631366163",
            "telephone_number": "314-800-6528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "TANJA",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-14",
        "last_updated": "2021-09-16",
        "certification_date": "2021-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MO",
            "license": "2014036364",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2014036364",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven M. Johnson, M.D.
• Summer Johnson
• Sydney Johnson, MD
• Tamara H Johnson, R.PH.
• Tammy Evette Johnson
• Teal Johnson
• Terry D Johnson
• Tiffany J Johnson, O.D.
• Tiffiny Johnson
• Valerie Latrice Johnson, WHNP-BC

• Family Nurse Practitioner in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Family Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.