Individual provider Active NPI

Valerie Johnson, NURSE PRACTITIONER

  • Family Nurse Practitioner
  • Kokomo, IN
National Provider Identifier
1629227434
Registry record updated Sep 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71002727 Issued in IN
Practice address
117 W Sycamore St
Kokomo, IN 46901-4634
Phone
(765) 854-2440
Fax
(765) 854-2450
NPI assigned
Sep 17, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 71002727 IN Primary

Addresses

Primary practice location

117 W Sycamore St
Kokomo, IN 46901-4634

Mailing address

6626 E 75TH St
Suite 500
Indianapolis, IN 46250-2890

Other identifiers 1

IdentifierTypeStateIssuer
200919480MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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 1

Enrollment IDStateProvider typePAC IDDetails
I20120419000044 IN Practitioner - Nurse Practitioner 6709047798 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fast Pace Medical Clinic PLLCGroup PAC ID 5395881841, 737 clinicians

Practice addresses (Care Compare)

4152 W State Rd
Suite 56
Hanover, IN 47243-9070
Phone (901) 351-1791

811 W Main St
Peru, IN 46970-1742
Phone (765) 470-4076

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
71002727INMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fast Pace Medical Clinic PLLC CurrentSince May 1, 2024 Accepting new patients
Fast Pace Medical Clinic PLLC CurrentSince May 1, 2024 Accepting new patients
FC Indiana, LLC CurrentSince Jun 22, 2024 Accepting new patients
Upperline Healthcare, PC CurrentSince Nov 1, 2025 Accepting new patients
FC Indiana, LLC CurrentSince Jun 22, 2024 Accepting new patients
Upperline Healthcare, PC CurrentSince Nov 1, 2025 Accepting new patients

Locations

1159 W Jefferson St
Ste 204
Franklin, IN 46131

4152 W State Road 56
Hanover, IN 47243
Phone (812) 762-4510

Organizations & group practices 6

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1221609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1411948800000",
    "number": "1629227434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6626 E 75TH ST",
            "address_2": "SUITE 500",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462502890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 W SYCAMORE ST",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469014634",
            "telephone_number": "765-854-2440",
            "fax_number": "765-854-2450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "VALERIE",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-17",
        "last_updated": "2014-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71002727",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200919480",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kokomo, IN

Sources for this page

Verify at the official NPI Registry.