Individual provider Active NPI

Katherine Johnson

  • Physician Assistant
  • Mandeville, LA
National Provider Identifier
1639067945
Registry record updated Jun 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
6593 Issued in TN
Practice address
948 Colewa CT
Mandeville, LA 70471-1510
Phone
(985) 788-3915
NPI assigned
Jun 25, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 6593 TN Primary

Addresses

Primary practice location

948 Colewa CT
Mandeville, LA 70471-1510

Mailing address

948 Colewa CT
Mandeville, LA 70471-1510

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20260129002731 TN Practitioner - Physician Assistant 2365920584 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Total Recovery Mind and Body PLLCGroup PAC ID 0840662425, 8 clinicians

Practice addresses (Care Compare)

5724 Western Ave
Knoxville, TN 37921-2224
Phone (865) 281-5480

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
6593TNMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Total Recovery Mind & Body PLLC CurrentSince Nov 20, 2025 Accepting new patients

Locations

5724 Western Ave
Knoxville, TN 37921
Phone (865) 281-5480

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.

NPI Registry JSON

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

{
    "created_epoch": "1750809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750809600000",
    "number": "1639067945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "948 COLEWA CT",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704711510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "948 COLEWA CT",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704711510",
            "telephone_number": "985-788-3915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KATHERINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-06-25",
        "last_updated": "2025-06-25",
        "certification_date": "2025-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "6593",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mandeville, LA

Sources for this page

Verify at the official NPI Registry.