Tina Johnson

Key facts

NPI

1629601711

Entity type

Individual (NPI type 1)

Primary specialty

Family Nurse Practitioner 363LF0000X

License

34085 (TN)

Practice address

110 Kittrell St
Hohenwald, TN 38462-1363

Phone

(931) 295-3406

NPI assigned

Feb 17, 2020

Sex

Female

Sole proprietor

Yes

Organizations & group practices 1

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.

• Durhurst Clinical Services, LLC Community/Retail Pharmacy · Hohenwald, TN · NPI 1194261651
  NPD

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/24835/brand/1/csg/1/fhir/r4

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 9, 2024.

{
    "created_epoch": "1581897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712620800000",
    "number": "1629601711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4006 PARK DR",
            "city": "COLUMBIA",
            "state": "TN",
            "postal_code": "384015025",
            "telephone_number": "931-698-6519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 KITTRELL ST",
            "city": "HOHENWALD",
            "state": "TN",
            "postal_code": "384621363",
            "telephone_number": "931-295-3406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "TINA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-02-17",
        "last_updated": "2024-04-09",
        "certification_date": "2024-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "F12190969",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "34085",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hohenwald, TN

• Bailee Marie Horton
• Treston Humphreys
• Tiffany Dawn Hurst, D.PH.
• James Ricky Jones
• Adria Johnson
• Azure Jones
• Jonathan Jones, PHARMD
• Joseph S. Hensley
• Jawaid Kamal, MD
• Jennifer Kelly Kilgore, LCSW

All providers in Hohenwald, TN · Family Nurse Practitioner in Tennessee