Individual provider Active NPI

Sandy Johnson, FNP-C

  • Family Nurse Practitioner
  • Puyallup, WA
National Provider Identifier
1669026407
Registry record updated Nov 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP61289177 Issued in WA
Practice address
1450 5TH St SE Ste 1100
Puyallup, WA 98372-4682
Phone
(253) 572-7320
NPI assigned
Jul 30, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP61289177 WA Primary

Addresses

Primary practice location

1450 5TH St SE Ste 1100
Puyallup, WA 98372-4682

Mailing address

1450 5TH St SE Ste 1100
Puyallup, WA 98372-4682
Phone (253) 572-7320

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20230831003902 WA Practitioner - Nurse Practitioner 3971928169 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Multicare Health SystemGroup PAC ID 7719899897, 2,312 clinicians

Practice addresses (Care Compare)

202 N Division St
Auburn, WA 98001-4939

222 State Ave N
Kent, WA 98030-4544
Phone (253) 372-7788

4700 Point Fosdick Dr
Gig Harbor, WA 98335-1706

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP61289177WAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System Nurse Practitioner CurrentSince Aug 2, 2023 Accepting new patients
Multicare Health System Current Accepting new patients
Multicare Health System CurrentSince Aug 2, 2023 Accepting new patients
Multicare Health System Nurse Practitioner Past Accepting new patients

Locations

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

222 State Ave N
Kent, WA 98030
Phone (253) 372-7680

311 S L St
Tacoma, WA 98405
Phone (253) 403-1444

Organizations & group practices 4

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1564444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730851200000",
    "number": "1669026407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1450 5TH ST SE STE 1100",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983724682",
            "telephone_number": "253-572-7320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 5TH ST SE STE 1100",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983724682",
            "telephone_number": "253-572-7320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "SANDY",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-30",
        "last_updated": "2024-11-06",
        "certification_date": "2024-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP61289177",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Puyallup, WA

Sources for this page

Verify at the official NPI Registry.