Roberta Lynn Johnson, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

LPN00047974 Issued in WA

Practice address

Intrepid Spirit Center 90390 Gardner Loop
Tacoma, WA 98431-0001

Phone

(253) 968-9017

NPI assigned

Jan 26, 2018

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

• Bobbie Stacey Other 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": "1516924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1780182584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8634 QUINAULT DR NE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985165826",
            "telephone_number": "360-789-5261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "INTREPID SPIRIT CENTER 90390 GARDNER LOOP",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984310001",
            "telephone_number": "253-968-9017"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Madigan Army Medical Center, 9040 JacksonAve",
            "address_2": "ATTN: MCHJ-CLQ-C",
            "address_purpose": "LOCATION",
            "city": "Tacoma",
            "state": "WA",
            "postal_code": "984311100",
            "country_code": "US",
            "telephone_number": "253-960-9017",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "ROBERTA",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-26",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "WA",
            "license": "LPN00047974",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BOBBIE",
            "last_name": "STACEY",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Raynai Johnson, LICSW
• Rebecca H Johnson, MD
• Rene Lawrence Johnson, PA-C
• Renee Marie Johnson, LMFTA
• Richard C Johnson, L.D.
• Robyn Lynn Johnson, LMP
• Safia Kassam Johnson, N.D.
• Sarah Johnson, RN
• Shawn M Johnson
• Shawna Lee Johnson, NP

• Licensed Practical Nurse in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Licensed Practical Nurse in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.