Jerrick Johnson, RN

Primary specialty

Rehabilitation Registered NurseTaxonomy code 163WR0400X

License

218478 Issued in AR

Practice address

100 Commercial Park CT Apt 145
Maumelle, AR 72113-6992

Phone

(501) 416-8867

NPI assigned

Jul 16, 2024

Last updated

Jul 16, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1721088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721088000000",
    "number": "1578301461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 COMMERCIAL PARK CT APT 145",
            "city": "MAUMELLE",
            "state": "AR",
            "postal_code": "721136992",
            "telephone_number": "501-416-8867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 COMMERCIAL PARK CT APT 145",
            "city": "MAUMELLE",
            "state": "AR",
            "postal_code": "721136992",
            "telephone_number": "501-416-8867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JERRICK",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-07-16",
        "last_updated": "2024-07-16",
        "certification_date": "2024-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "146D00000X",
            "taxonomy_group": "",
            "desc": "Personal Emergency Response Attendant",
            "state": "AR",
            "license": "11221112610",
            "primary": false
        },
        {
            "code": "163WR0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Rehabilitation",
            "state": "AR",
            "license": "218478",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jaliyah Jackson
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• Jeff J. Carfagno, M.D., P.a.
• Joanna's Transportation Service, LLC
• Ginger R Johnson, D.C.
• Lisa Ann Johnson, R.PH.
• Shante Johnson
• Julie Anna Kaylor, CGC
• Holly Keith
• Kristina D Keller, LPC

• Rehabilitation Registered Nurse in Maumelle, AR
• Providers in Maumelle, AR by specialty
• Rehabilitation Registered Nurse in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2024; 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.