Shannon L Johnson, CNP, APRN, CNS-RX

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

60090 Issued in OK

Practice address

1600 SW 119TH St
Oklahoma City, OK 73170-4908

Phone

(405) 425-8100

Fax

(405) 425-8109

NPI assigned

Oct 5, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Shannon L Clink Former name

Medicare fee-for-service enrollment

Enrolled in OK

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

Specialty

Nurse Practitioner

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Complete and Comprehensive Kidney Care PLLCGroup PAC ID 3375979263, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Certified Nurse Specialist

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sjohnson542086@direct-ehr-ssmhc.com

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.

• Complete & Comprehensive Kidney Care PLLC

  • Adolescent Medicine (Internal Medicine) Physician
  • Oklahoma City, OK
  • NPI 1922647585
  Medicare reassignment Care Compare group NPD
• Fazal Akbar Ali MD PC

  • Nephrology Physician
  • Oklahoma City, OK
  • NPI 1730515362
  Medicare reassignment NPD

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

{
    "created_epoch": "1128470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454630400000",
    "number": "1639166499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5300 N INDEPENDENCE AVE",
            "address_2": "STE. 280",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731125556",
            "telephone_number": "405-425-8100",
            "fax_number": "405-425-8109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 SW 119TH ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731704908",
            "telephone_number": "405-425-8100",
            "fax_number": "405-425-8109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "SHANNON",
        "middle_name": "L",
        "credential": "CNP, APRN, CNS-RX",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-05",
        "last_updated": "2016-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OK",
            "license": "60090",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "60090",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200030250A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "CLINK",
            "middle_name": "L",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Robin Renee Johnson, ARNP
• Ruth Johnson
• Ryan Johnson
• Sarah Elizabeth Johnson
• Scott H Johnson, M.D.
• Sharrell Johnson, LCSW
• Shatrice Johnson, LPC-C
• Shaye Ann Johnson I
• Shayla Johnson
• Sheila Jeanette Johnson, MASTERS IN EDUCATION

• Family Nurse Practitioner in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Family Nurse Practitioner in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.