Stacy Johnson, MSN, APRN, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

M86384 Issued in OK

Practice address

1261 E Tulsa Ave
Kansas, OK 74347-7026

Phone

(918) 868-2175

Fax

(479) 373-6069

NPI assigned

Sep 27, 2018

Last updated

Sep 27, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OK, AR2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St. Francis House Nwa, Inc.Group PAC ID 0042262495, 67 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Oklahoma Healthcare Solutions XI Home health agency, Gore, OK, CCN 377750
• Siloam Springs Regional Hospital Hospital, Siloam Springs, AR, CCN 040001

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• St Francis House Nwa, Inc

  dba Community Clinic West Fork

  • Federally Qualified Health Center (FQHC)
  • West Fork, AR
  • NPI 1336986785
  Medicare reassignment Care Compare group NPD
• St Francis House Nwa, Inc

  dba Community Clinic Fayetteville High School

  • Federally Qualified Health Center (FQHC)
  • Fayetteville, AR
  • NPI 1316639149
  NPD
• St. Francis House Nwa, Inc.

  dba Community Clinic Rogers Medical

  • Federally Qualified Health Center (FQHC)
  • Rogers, AR
  • NPI 1710160098
  NPD (past)

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

• Country Style Health Care, Inc. XI

  dba Oklahoma Healthcare Solutions XI

  • Home Health Agency
  • Gore, OK
  • NPI 1255641155
  Care Compare affiliation
• Siloam Springs Arkansas Hospital Company LLC

  dba Siloam Springs Regional Hospital

  • General Acute Care Hospital
  • Siloam Springs, AR
  • NPI 1902051816
  Care Compare affiliation

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

{
    "created_epoch": "1538006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538006400000",
    "number": "1548745334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1261 E TULSA AVE",
            "city": "KANSAS",
            "state": "OK",
            "postal_code": "743477026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1261 E TULSA AVE",
            "city": "KANSAS",
            "state": "OK",
            "postal_code": "743477026",
            "telephone_number": "918-868-2175",
            "fax_number": "479-373-6069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "STACY",
        "name_prefix": "Mrs.",
        "credential": "MSN, APRN, FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-27",
        "last_updated": "2018-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AR",
            "license": "A005920",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "M86384",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Grand Lake Mental Health Center, Inc. (GRAND Mental Health)
• Grand Lake Mental Health Center, Inc. (GRAND Mental Health)
• Grand Lake Mental Health Center, Inc. (GRAND Mental Health)
• Leslie Gregory
• Kansas Pharmacy LLC (Kansas Pharmacy)
• Kansas Public Schools
• Ranae Luper
• Catherine Shanon Maddan, LMSW-P U/S
• Molly Martin, MD

• Family Nurse Practitioner in Kansas, OK
• Providers in Kansas, OK by specialty
• Family Nurse Practitioner in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2018; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.