Mattison Brooke Johnson I, LVN

Primary specialty

Attendant Care ProviderTaxonomy code 3747A0650X

Practice address

8615 Fletcher Pkwy Unit 406
La Mesa, CA 91942-5205

Phone

(209) 570-6823

NPI assigned

Sep 3, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1567468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582588800000",
    "number": "1710535687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8615 FLETCHER PKWY UNIT 406",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919425205",
            "telephone_number": "209-570-6823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8615 FLETCHER PKWY UNIT 406",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919425205",
            "telephone_number": "209-570-6823"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6741 108th St # A",
            "address_purpose": "LOCATION",
            "city": "Ewa Beach",
            "state": "HI",
            "postal_code": "967063318",
            "country_code": "US",
            "telephone_number": "209-570-6823",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MATTISON",
        "middle_name": "BROOKE",
        "name_suffix": "I",
        "credential": "LVN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-09-03",
        "last_updated": "2020-02-25",
        "certification_date": "2020-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "696096",
            "primary": false
        },
        {
            "code": "3747A0650X",
            "taxonomy_group": "",
            "desc": "Technician, Attendant Care Provider",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRIVER LICENSE",
            "identifier": "F5653277",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mattie1313@hotmail.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "6741 108th St # A",
            "city": "Ewa Beach",
            "state": "HI",
            "country_code": "US",
            "postal_code": "967063318",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• John W. Allen, M.D.
• Ashley M. Johnson
• Charmie Johnson, CHLS
• James Avery Johnson, MD
• Jonathan Edward Johnson, D.C.
• Nancy Denise Johnson, MFT
• Peter Fink Johnson, D.M.D.
• Ronald M Johnson, MD
• Shevanthi Rebekah Johnson, DDS
• Stacy Kim Johnston, PHD

• Attendant Care Provider in La Mesa, CA
• Providers in La Mesa, CA by specialty
• Attendant Care Provider in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2020; 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.