Individual provider Active NPI

Kyler Michelle Johnson, PHYSICIAN ASSISTANT

  • Physician Assistant
  • Kearney, NE
National Provider Identifier
1477390680
Registry record updated Feb 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3399 Issued in NE
Practice address
211 W 33Rd St
Kearney, NE 68845-3484
Phone
(308) 865-2141
Fax
(308) 856-2150
NPI assigned
Jul 15, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 3399 NE Primary

Addresses

Primary practice location

211 W 33Rd St
Kearney, NE 68845-3484

Mailing address

211 W 33Rd St
Kearney, NE 68845-3484
Phone (308) 865-2141

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE
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
I20260224003304 NE Practitioner - Physician Assistant 2466933874 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alegent Creighton ClinicGroup PAC ID 1951210418, 951 clinicians

Practice addresses (Care Compare)

211 W 33Rd St
Kearney, NE 68845-3484
Phone (308) 865-2141

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3399NEMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Alegent Creighton Clinic CurrentSince Mar 1, 2026 Accepting new patients
Alegent Creighton Clinic Physician Assistant Past Accepting new patients
Unmc Physicians PastSince Jul 21, 2024 Accepting new patients
Nebraska Pediatric Practice, Inc PastSince Jul 21, 2024 Accepting new patients

Locations

2771 Solution Ctr
Chicago, IL 60677

211 W 33rd St
Kearney, NE 68845
Phone (308) 236-5884

16909 Lakeside Hills Ct
Ste 401
Omaha, NE 68130
Phone (402) 827-4920

Organizations & group practices 4

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1721001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771200000000",
    "number": "1477390680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 W 33RD ST",
            "city": "KEARNEY",
            "state": "NE",
            "postal_code": "688453484",
            "telephone_number": "308-865-2141",
            "fax_number": "308-865-2150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 W 33RD ST",
            "city": "KEARNEY",
            "state": "NE",
            "postal_code": "688453484",
            "telephone_number": "308-865-2141",
            "fax_number": "308-856-2150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KYLER",
        "middle_name": "MICHELLE",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-15",
        "last_updated": "2026-02-16",
        "certification_date": "2026-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": "3399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kearney, NE

Sources for this page

Verify at the official NPI Registry.