Jaclyn Nicole Johnson, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

4171 Issued in WV

Practice address

202 Tunnelton St
Ste 214
Kingwood, WV 26537-1452

Phone

(304) 329-1989

NPI assigned

Jun 20, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WV

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1434758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1434758400000",
    "number": "1508248022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 TUNNELTON ST",
            "address_2": "STE 214",
            "city": "KINGWOOD",
            "state": "WV",
            "postal_code": "265371452",
            "telephone_number": "304-329-1989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 TUNNELTON ST",
            "address_2": "STE 214",
            "city": "KINGWOOD",
            "state": "WV",
            "postal_code": "265371452",
            "telephone_number": "304-329-1989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JACLYN",
        "middle_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-20",
        "last_updated": "2015-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WV",
            "license": "4171",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donald Hoffman, M.D.
• Zachary Nathan Hoover, PRC
• Ryan Hovatter, PHARMD
• Cassandra Marie Howell, BSN
• Angela Darlene Huffman
• Nancy Louise Jones, PAC CWS
• Ashley E Jose, DPT
• Kamp Central Ambulance Service, Inc.
• John Joseph Keefe, MD.
• Julia Lynn Keller

• Dentist in Kingwood, WV
• Providers in Kingwood, WV by specialty
• Dentist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2015; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.