Individual provider Active NPI

Kerri Suzanne Johnson

  • Adult Psychiatric/Mental Health Clinical Nurse Specialist
  • Asheboro, NC
National Provider Identifier
1659931780
Registry record updated Jun 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Psychiatric/Mental Health Clinical Nurse SpecialistTaxonomy code 364SP0809X
License
63798 Issued in NC
Practice address
110 W Walker Ave
Asheboro, NC 27203-6760
Phone
(336) 633-7000
NPI assigned
Jun 20, 2019
Last updated
Jun 20, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Psychiatric/Mental Health Clinical Nurse Specialist 364SP0809X 63798 NC Primary

Addresses

Primary practice location

110 W Walker Ave
Asheboro, NC 27203-6760

Mailing address

110 W Walker Ave
Asheboro, NC 27203-6760
Phone (336) 633-7000

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

LicenseStateTypeSpecialty
63798NCMDAdult Psychiatric/Mental Health Clinical Nurse Specialist

NPI Registry JSON

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

{
    "created_epoch": "1560988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560988800000",
    "number": "1659931780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 W WALKER AVE",
            "city": "ASHEBORO",
            "state": "NC",
            "postal_code": "272036760",
            "telephone_number": "336-633-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 W WALKER AVE",
            "city": "ASHEBORO",
            "state": "NC",
            "postal_code": "272036760",
            "telephone_number": "336-633-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KERRI",
        "middle_name": "SUZANNE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-20",
        "last_updated": "2019-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SP0809X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health, Adult",
            "state": "NC",
            "license": "63798",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Asheboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.