Jackie Ann Johnson

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

LPN69057 Issued in TN

Practice address

627 Smithview Dr
Maryville, TN 37803-6100

Phone

(865) 380-4390

Fax

(865) 380-4396

NPI assigned

Oct 19, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jackie Ann Wilbert Former name

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": "1255910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1255910400000",
    "number": "1740516251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPT 888182",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379958182",
            "telephone_number": "800-355-3565",
            "fax_number": "423-714-2355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "627 SMITHVIEW DR",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378036100",
            "telephone_number": "865-380-4390",
            "fax_number": "865-380-4396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JACKIE",
        "middle_name": "ANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-10-19",
        "last_updated": "2009-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "TN",
            "license": "LPN69057",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACKIE",
            "last_name": "WILBERT",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Annalysa M Johnson, D.O.
• Aubrey Sky Johnson, MSOT, OTR/L
• Baron P Johnson, PT
• Cynthia Johnson
• Hannah Laurel Johnson, FNP-C
• Mikall Johnson
• Nancy Mandrell Johnson, LPN
• Sarai Lynn Johnson
• Whitley Johnson, FNP
• Justinas Joksas, BA

• Licensed Practical Nurse in Maryville, TN
• Providers in Maryville, TN by specialty
• Licensed Practical Nurse in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2009; 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.