Jeremiah Johnson, BSN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

RN60268562 Issued in WA

Practice address

850 Maple St.
Medical Lake, WA 99022

Phone

(509) 565-4000

NPI assigned

Sep 18, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor on Science - Nursing

State licenses

Practice roles

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.

• Department of Social Dept of SHS Div of Instns

  • Psychiatric Hospital
  • Medical Lake, WA
  • NPI 1467440602
  NPD (past)

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

{
    "created_epoch": "1410998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410998400000",
    "number": "1669874913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13310 E MISSION AVE",
            "address_2": "APT #114",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992162723",
            "telephone_number": "509-481-7650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 MAPLE ST.",
            "city": "MEDICAL LAKE",
            "state": "WA",
            "postal_code": "99022",
            "telephone_number": "509-565-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JEREMIAH",
        "credential": "BSN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-09-18",
        "last_updated": "2014-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WA",
            "license": "RN60268562",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melisa Renae Holdway, LMHC
• Ulista Hoover, M.D.
• David J Hughes
• Serban I Ionescu, MD
• Ja Medical Center PS
• Sage Nicole Johnson
• Angela Louise Jones, LMP
• Keblawi Pediatrics, PLLC
• Sabrina Arnott Keckalo, PA-C
• Emma D Keller

• Registered Nurse in Medical Lake, WA
• Providers in Medical Lake, WA by specialty
• Registered Nurse in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2014; 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.