Johanna Powden Golston, RN, NP
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · South Burlington, VT
NPI 1720146772 · NPPES record last updated Jul 15, 2024
Key facts
- NPI
- 1720146772
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 101.0136722 (VT)
- Practice address
- 595 Dorset St Ste 4
South Burlington, VT 05403-6240 - Phone
- (802) 489-5552
- Fax
- (802) 488-5465
- NPI assigned
- Dec 4, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA, VT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100610000779 | CA | Practitioner - Nurse Practitioner | 9931239399 | Reassigns benefits to 1 organization |
| I20240626001078 | VT | Practitioner - Nurse Practitioner | 9931239399 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 647378 | CA | MD | Registered Nurse |
| 19126 | CA | MD | Psychiatric/Mental Health Nurse Practitioner |
| 101.0136722 | VT | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mental Health Specialty Group PA | Current |
Accepting new patients | |
| Primary Care Health Partners - New York LLP | Past |
Accepting new patients |
Locations
145 Pine Haven Shores Rd
Ste 100077
Shelburne, VT 05482
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 647378 | CA | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 19126 | CA | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 101.0136722 | VT | Yes |
Addresses
Primary practice location
595 Dorset St Ste 4
South Burlington, VT 05403-6240
Mailing address
359 North Rd
Hinesburg, VT 05461-9127
Phone (805) 610-4542
Other practice location 1
2180 Harvard St Ste 210
Sacramento, CA 95815-3318
Phone (855) 427-2778
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jgolston@pchpmd.medentdirect.com | Direct |
Other providers in South Burlington, VT
- John Glemb
- Gina M Godek
- Zachary Godin
- Anne M Goldman
- Casey Goldman
- Goodhealth Diagnostic Center, Inc.
- Goodhealth P.C.
- Goodhealth, P.C.
- Robert Macy Goodman
- Joanna Gould
All providers in South Burlington, VT · Psychiatric/Mental Health Nurse Practitioner in Vermont
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 15, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.