Nancy Kelly Johnson, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD17293 Issued in OR

Practice address

11790 SW Barnes Rd Ste 140
Portland, OR 97225-5938

Phone

(503) 646-0161

Fax

(503) 643-7459

NPI assigned

Oct 5, 2006

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

Other names 1

• Nancy Norwood Kelly Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634774400000",
    "number": "1861589681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11790 SW BARNES RD STE 140",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255938",
            "telephone_number": "503-643-2100",
            "fax_number": "503-643-7459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11790 SW BARNES RD STE 140",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255938",
            "telephone_number": "503-646-0161",
            "fax_number": "503-643-7459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "NANCY",
        "middle_name": "KELLY",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-05",
        "last_updated": "2021-10-21",
        "certification_date": "2021-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OR",
            "license": "MD17293",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "058474",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NANCY",
            "last_name": "KELLY",
            "middle_name": "NORWOOD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Melody Kaye Johnson
• Melody L Johnson, L.M.T.
• Milton Charles Johnson, M.D.
• Monica Johnson, MD
• Naimah Johnson, QMHA-I
• Natalea Johnson
• Nathalie George Johnson, M.D.
• Nathan B Johnson
• Nicholle Leigh Johnson
• Nicole Kathleen Johnson, DNP, APRN, CRNA

• Pediatrics Physician in Portland, OR
• Providers in Portland, OR by specialty
• Pediatrics Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2021; 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.