Active NPI
Jessica E. Johnson, RN
- Registered Nurse
- Charleston, WV
National Provider Identifier
1619691276
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 103305
- Practice address
- 400 Tracy Way Ste 100
Charleston, WV 25311-1280 - Phone
- (304) 720-0205
- Fax
- (304) 720-0262
- NPI assigned
- Sep 28, 2022
- Last updated
- Sep 28, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 103305 | WV | Primary |
Addresses
Primary practice location
400 Tracy Way Ste 100
Charleston, WV 25311-1280
Mailing address
400 Tracy Way Ste 100
Charleston, WV 25311-1280
Phone (304) 720-0205
Other names 1
- Jessica E Ray
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Desktop/Tablet |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 103305 | WV | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Primary Care at Home of West Virginia, LLC | Past | Accepting new patients | |
| Mountaineer Homecare, LLC | Past | Accepting new patients |
Organizations & group practices 2
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.
-
dba Primary Care at Home of Charleston
- Nurse Practitioner
- Charleston, WV
- NPI 1386163392
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1664323200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664323200000",
"number": "1619691276",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 TRACY WAY STE 100",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253111280",
"telephone_number": "304-720-0205",
"fax_number": "304-720-0262"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 TRACY WAY STE 100",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253111280",
"telephone_number": "304-720-0205",
"fax_number": "304-720-0262"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "JESSICA",
"middle_name": "E.",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-09-28",
"last_updated": "2022-09-28",
"certification_date": "2022-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "WV",
"license": "103305",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "Desktop/Tablet",
"affiliation": "N",
"address_1": "400 Tracy Way Ste 100",
"city": "Charleston",
"state": "WV",
"country_code": "US",
"postal_code": "253111280",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "JESSICA",
"last_name": "RAY",
"middle_name": "E",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Charleston, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.