Staci L Johnson, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1097 Issued in AK

Practice address

2751 Debarr Rd Ste 310
Anchorage, AK 99508-6804

Phone

(907) 277-9700

Fax

(907) 868-1215

NPI assigned

Aug 5, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/12186/brand/1/csg/1/fhir/r4
• Direct secure messaging: staci.johnson.1@12186.direct.athenahealth.com

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.

• Obhg Alaska, P.C.

  • Obstetrics & Gynecology Physician
  • Anchorage, AK
  • NPI 1740697069

  Multi-Specialty

  NPD (past)
• Vitae Integrative Medical Center

  • Clinic/Center
  • Anchorage, AK
  • NPI 1760852388
  NPD (past)

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

{
    "created_epoch": "1217894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601337600000",
    "number": "1538325907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2751 DEBARR RD STE 310",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995086804",
            "telephone_number": "907-277-9700",
            "fax_number": "907-868-1215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2751 DEBARR RD STE 310",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995086804",
            "telephone_number": "907-277-9700",
            "fax_number": "907-868-1215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "STACI",
        "middle_name": "L",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-08-05",
        "last_updated": "2020-09-29",
        "certification_date": "2020-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Pain Management",
            "state": "AK",
            "license": "1097",
            "primary": false
        },
        {
            "code": "163WW0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Wound Care",
            "state": "AK",
            "license": "1097",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AK",
            "license": "1097",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1022282",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Seth Johnson
• Shawne Johnson
• Sherry Johnson, D.O. FACS
• Shontale Denise Johnson, LCSW
• Skye Johnson
• Steven Johnson, MD
• Susan Harding Johnson, DPT
• Susan McCambly Johnson, PHYSICIAN ASSISTANT
• Taylor Johnson
• Theresa Johnson

• Family Nurse Practitioner in Anchorage, AK
• Providers in Anchorage, AK by specialty
• Family Nurse Practitioner in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.