Icephine Ballard Johnson, NURSE PRACTITIONER

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

R 107237-0 Issued in MN

Practice address

720 4TH Ave S
Saint Cloud, MN 56301-4442

Phone

(320) 308-4861

Fax

(320) 308-3192

NPI assigned

Mar 9, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1141862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1568430346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 4TH AVE S",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563014442",
            "telephone_number": "320-308-4861",
            "fax_number": "320-308-3192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 4TH AVE S",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563014442",
            "telephone_number": "320-308-4861",
            "fax_number": "320-308-3192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "ICEPHINE",
        "middle_name": "BALLARD",
        "name_prefix": "Mrs.",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-09",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MN",
            "license": "R 107237-0",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EIN",
            "identifier": "41687554",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Donna F Johnson, MS LP
• Dustin Johnson
• Filip Lee Johnson, P.T.
• Gary L Johnson, M.D.
• Heather Johnson
• Jacqueline Ann Johnson, WHNP
• Janelle L Johnson, MD
• Jeanette Johnson
• Jeffrey Todd Johnson, ATC
• John C Johnson, MD

• Adult Health Nurse Practitioner in Saint Cloud, MN
• Providers in Saint Cloud, MN by specialty
• Adult Health Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.