Amanda Johnson

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

202211248NP-PP Issued in OR

Practice address

1810 N 4TH St
Lakeview, OR 97630-1003

Phone

(541) 600-2535

Fax

(541) 325-4804

NPI assigned

Sep 13, 2022

Last updated

Sep 5, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Feb 25, 2025 through Feb 25, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mae Medical

  • Family Medicine Physician
  • Lakeview, OR
  • NPI 1164100756
  Authorized official Same address or phone

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

{
    "created_epoch": "1663027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757030400000",
    "number": "1730801127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1168",
            "city": "LAKEVIEW",
            "state": "OR",
            "postal_code": "976300046",
            "telephone_number": "541-600-2535",
            "fax_number": "541-325-4804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1810 N 4TH ST",
            "city": "LAKEVIEW",
            "state": "OR",
            "postal_code": "976301003",
            "telephone_number": "541-600-2535",
            "fax_number": "541-325-4804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "AMANDA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-09-13",
        "last_updated": "2025-09-05",
        "certification_date": "2025-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "202211248NP-PP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSE PRACTITIONER",
            "identifier": "202211248NP-PP",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Howard's Pharmacy Inc. (Howard's Drugs)
• Howard's Pharmacy Inc.
• Howards Pharmacy Inc (Howards Drugs)
• Stephen A Hussey, M.D.
• Alexander Johnson
• Taylor Christine Johnston, QMHA, CADC
• Olivia M Kappel, LMT, CST, NUT
• Kindred Circle Care LLC
• Kindred Heritage DME LLC
• Klamath Ophthalmology, PC (Lakeview Eye Center)

• Family Nurse Practitioner in Lakeview, OR
• Providers in Lakeview, OR by specialty
• Family Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.