Active NPI
Georgette Johnson, PSYD
- Clinical Child & Adolescent Psychologist
- Cape Girardeau, MO
National Provider Identifier
1467406728
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 1999140485
- Practice address
- 619 N Broadview St
Cape Girardeau, MO 63701-4313 - Phone
- (573) 334-3486
- Fax
- (573) 334-3524
- NPI assigned
- May 20, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | 1999140485 | MO | Primary |
Addresses
Primary practice location
619 N Broadview St
Cape Girardeau, MO 63701-4313
Mailing address
2700 Wedgewood Dr
Jackson, MO 63755-3251
Phone (573) 334-7471
Other identifiers 13
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 146377 | Other | BLUE CROSS BLUE SHIELD | |
| 430142 | Other | CENTURY PLANNERS | |
| 430142 | Other | FORTIS/HL | |
| 430142 | Other | HEALTHLINK | |
| 431823864 | Other | MAGELLAN | |
| 430142 | Other | HEALTHLINK FREEDOM | |
| 431823864 | Other | MULTIPLAN | |
| 493874812 | Medicaid | MO | |
| 43042 | Other | EPOCH | |
| 431823864 | Other | MO | CORPHEALTH |
| 431823864 | Other | GREATWEST | |
| 431823864 | Other | MISSOURI ALLIANCE | |
| 5633811 | Other | FIRSTHEALTH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1999140485 | MO | MD | Clinical Child & Adolescent Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148083200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209600000000",
"number": "1467406728",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2700 WEDGEWOOD DR",
"city": "JACKSON",
"state": "MO",
"postal_code": "637553251",
"telephone_number": "573-334-7471"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "619 N BROADVIEW ST",
"city": "CAPE GIRARDEAU",
"state": "MO",
"postal_code": "637014313",
"telephone_number": "573-334-3486",
"fax_number": "573-334-3524"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "GEORGETTE",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-20",
"last_updated": "2008-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "MO",
"license": "1999140485",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "146377",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CENTURY PLANNERS",
"identifier": "430142",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FORTIS/HL",
"identifier": "430142",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK",
"identifier": "430142",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN",
"identifier": "431823864",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK FREEDOM",
"identifier": "430142",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MULTIPLAN",
"identifier": "431823864",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "493874812",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EPOCH",
"identifier": "43042",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CORPHEALTH",
"identifier": "431823864",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GREATWEST",
"identifier": "431823864",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MISSOURI ALLIANCE",
"identifier": "431823864",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRSTHEALTH",
"identifier": "5633811",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Cape Girardeau, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.