Sasha Renae Domerese, NP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

A006062 Issued in AR

Practice address

25 Professional Park Dr
Clarksville, AR 72830

Phone

(479) 705-8181

Fax

(479) 705-0041

NPI assigned

Jan 23, 2019

Last updated

Aug 11, 2026By the provider in NPPES

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

Other names 1

• Sasha Renae Johnson Former name

Medicare fee-for-service enrollment

Enrolled in AR

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

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Robert Frederick Noonan Jr MD PAGroup PAC ID 5890892830, 5 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Johnson Regional Medical Center Hospital, Clarksville, AR, CCN 040002

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sjohnson@cfmc-ar.direct.office.nextgen.com

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.

• Robert Frederick Noonan Jr MD PA

  dba Clarksville Family Medical Center

  • Family Medicine Physician
  • Clarksville, AR
  • NPI 1477512127
  Medicare reassignment Care Compare group NPD
• East Arkansas Emergency Physicians, PLLC

  • Emergency Medicine Physician
  • Blytheville, AR
  • NPI 1932442985

  Nurse Practitioner

  Medicare reassignment NPD
• East Arkansas Emergency Physicians, PLLC

  • Emergency Medicine Physician
  • Clarksville, AR
  • NPI 1609259753

  Nurse Practitioner

  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Johnson Regional Medical Center

  • General Acute Care Hospital
  • Clarksville, AR
  • NPI 1134116049
  Care Compare affiliation

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

{
    "created_epoch": "1548201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786406400000",
    "number": "1861956922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 PROFESSIONAL PARK DR",
            "city": "CLARKSVILLE",
            "state": "AR",
            "postal_code": "728304432",
            "telephone_number": "479-705-8181",
            "fax_number": "479-705-0041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 PROFESSIONAL PARK DR",
            "city": "CLARKSVILLE",
            "state": "AR",
            "postal_code": "72830",
            "telephone_number": "479-705-8181",
            "fax_number": "479-705-0041"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1100 E Poplar St",
            "address_purpose": "LOCATION",
            "city": "Clarksville",
            "state": "AR",
            "postal_code": "728304419",
            "country_code": "US",
            "telephone_number": "479-754-5454 x400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1100 E Poplar St",
            "address_purpose": "LOCATION",
            "city": "Clarksville",
            "state": "AR",
            "postal_code": "728304419",
            "country_code": "US",
            "telephone_number": "479-754-5454 x400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOMERESE",
        "first_name": "SASHA",
        "middle_name": "RENAE",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-23",
        "last_updated": "2026-08-11",
        "certification_date": "2026-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AR",
            "license": "A006062",
            "primary": true
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "AR",
            "license": "A006062",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SASHA",
            "last_name": "JOHNSON",
            "middle_name": "RENAE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Nurse Practitioner in Clarksville, AR
• Providers in Clarksville, AR by specialty
• Nurse Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.