Individual provider Active NPI

Wendy D Johnson, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Killeen, TX
National Provider Identifier
1457646812
Registry record updated Nov 7, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
AP130942 Issued in TX
Practice address
2301 S Clear Creek Rd Ste 216
Killeen, TX 76549-4198
Phone
(254) 519-8803
NPI assigned
Jun 14, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X AP130942 TX Primary

Addresses

Primary practice location

2301 S Clear Creek Rd Ste 216
Killeen, TX 76549-4198

Mailing address

2301 S Clear Creek Rd Ste 216
Killeen, TX 76549-4198
Phone (254) 519-8803

Other identifiers 1

IdentifierTypeStateIssuer
816036MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
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

Enrollment IDStateProvider typePAC IDDetails
I20201203001310 LA Practitioner - Nurse Practitioner 4981878170 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ochsner Clinic LLCGroup PAC ID 8224933619, 2,845 clinicians

Practice addresses (Care Compare)

502 Rue de Sante
La Place, LA 70068-5424
Phone (504) 464-8588

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP130942TXMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ochsner Clinic LLC Current Accepting new patients
Ochsner Clinic LLC CurrentSince Nov 16, 2020 Accepting new patients
Ochsner Clinic LLC CurrentSince Nov 16, 2020 Accepting new patients

Locations

104 Acadia Park Dr
Raceland, LA 70394
Phone (985) 537-3211

Interoperability endpoints

  • Direct secure messaging: wjohnson949093@direct.ochsner.org

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1308009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1510012800000",
    "number": "1457646812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 S CLEAR CREEK RD STE 216",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "765494198",
            "telephone_number": "254-519-8803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 S CLEAR CREEK RD STE 216",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "765494198",
            "telephone_number": "254-519-8803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "WENDY",
        "middle_name": "D",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-14",
        "last_updated": "2017-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "AP130942",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "816036",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Killeen, TX

Sources for this page

Verify at the official NPI Registry.