Kimberly Sanders Johnson, PA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

TEMPORARY PERMIT Issued in TN

Practice address

9430 Park West Blvd
# 130
Knoxville, TN 37923-4200

Phone

(865) 690-4861

Fax

(865) 560-8252

NPI assigned

Feb 4, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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

• Southeastern Emergency Physicians LLC

  • Emergency Medicine Physician
  • Maysville, KY
  • NPI 1356379382

  TN

  Medicare reassignment
• Cane Ridge Emergency Physicians LLC

  • Emergency Medicine Physician
  • Smyrna, TN
  • NPI 1275815433
  NPD (past)
• Sparrow Emergency Physicians PLLC

  • Emergency Medicine Physician
  • Knoxville, TN
  • NPI 1225408339

  Physician Assistant

  NPD (past)

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

{
    "created_epoch": "1265241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359676800000",
    "number": "1821320656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 32569",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379302569",
            "telephone_number": "865-694-0062",
            "fax_number": "865-694-7907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9430 PARK WEST BLVD",
            "address_2": "# 130",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379234200",
            "telephone_number": "865-690-4861",
            "fax_number": "865-560-8252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KIMBERLY",
        "middle_name": "SANDERS",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-02-04",
        "last_updated": "2013-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TN",
            "license": "TEMPORARY PERMIT",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "PA0000001820",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine Margaret Johnson, APRN-FNP-BC
• Katherine Nicole Johnson
• Kellye S Johnson, CRNA
• Kelsey Johnson, M.ED
• Kevin Johnson
• Kristyn Leigh Johnson, PTA
• Kynslee Nicole Johnson
• Landon Mark Johnson, PHARMD
• Lauren E Johnson, CRNA
• Lauren Elaine Johnson

• Surgical Physician Assistant in Knoxville, TN
• Providers in Knoxville, TN by specialty
• Surgical Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.