Active NPI
Nichole Rene' Johnson, RD/LD
- Registered Dietitian
- Shawnee, OK
National Provider Identifier
1639266414
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- LD 873
- Practice address
- 2 E. Main Street
Shawnee, OK 74801 - Phone
- (405) 826-6441
- Fax
- (405) 878-0162
- NPI assigned
- Oct 5, 2006
- Last updated
- Jul 9, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 Dietitian | 133V00000X | LD 873 | OK | Primary |
Addresses
Primary practice location
2 E. Main Street
Shawnee, OK 74801
Mailing address
2 E. Main Street
Shawnee, OK 74801
Phone (405) 826-6441
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LD 873 | OK | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1639266414",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 E. MAIN STREET",
"city": "SHAWNEE",
"state": "OK",
"postal_code": "74801",
"telephone_number": "405-826-6441",
"fax_number": "405-878-0162"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 E. MAIN STREET",
"city": "SHAWNEE",
"state": "OK",
"postal_code": "74801",
"telephone_number": "405-826-6441",
"fax_number": "405-878-0162"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "NICHOLE",
"middle_name": "RENE'",
"name_prefix": "Mrs.",
"credential": "RD/LD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-05",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "OK",
"license": "LD 873",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shawnee, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.