Individual provider Active NPI

Pamela Tate Johnson

  • Family Nurse Practitioner
  • Andalusia, AL
National Provider Identifier
1679231955
Registry record updated Dec 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1-070398 Issued in AL
Practice address
508 E Three Notch St
Andalusia, AL 36420-3128
Phone
(334) 362-2015
NPI assigned
Dec 3, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2021

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 1-070398 AL Primary

Addresses

Primary practice location

508 E Three Notch St
Andalusia, AL 36420-3128

Mailing address

1500 1St Ave N Unit 3
Birmingham, AL 35203-1866
Phone (205) 545-5088

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220203002720 AL Practitioner - Nurse Practitioner 9234522798 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1-070398ALMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Rural Urgent Care LLC CurrentSince Dec 28, 2021 Accepting new patients
Rural Urgent Care LLC CurrentSince Dec 28, 2021 Accepting new patients

Locations

508 E Three Notch St
Ste 100
Andalusia, AL 36420
Phone (334) 362-2015

508 E Three Notch St
Andalusia, AL 36420
Phone (334) 362-2015

1500 1st Ave N
Unit 3
Birmingham, AL 35203
Phone (205) 545-5088

1925 W Main St
#120
Centre, AL 35960
Phone (256) 677-4552

1026 S Eufaula Ave
Eufaula, AL 36027
Phone (334) 687-5775

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1638489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638489600000",
    "number": "1679231955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 1ST AVE N UNIT 3",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352031866",
            "telephone_number": "205-545-5088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "508 E THREE NOTCH ST",
            "city": "ANDALUSIA",
            "state": "AL",
            "postal_code": "364203128",
            "telephone_number": "334-362-2015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "PAMELA",
        "middle_name": "TATE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-03",
        "last_updated": "2021-12-03",
        "certification_date": "2021-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-070398",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Andalusia, AL

Sources for this page

Verify at the official NPI Registry.