Michael James Johnson, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

595 Issued in CO

Practice address

1008 Minnequa Ave
Pueblo, CO 81004-3733

Phone

(719) 560-5656

Fax

(719) 560-4715

NPI assigned

Jul 18, 2006

Sex

Male

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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1891714234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "445 E CHEYENNE MOUNTAIN BLVD STE C PMB 406",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809064570",
            "telephone_number": "719-538-8100",
            "fax_number": "719-538-8003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1008 MINNEQUA AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810043733",
            "telephone_number": "719-560-5656",
            "fax_number": "719-560-4715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MICHAEL",
        "middle_name": "JAMES",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "595",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "970016858",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07005952",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katheryn Johnson, CPT, CRNA, PTC
• Katy Suzanne Johnson, LMT
• Kerri L. Johnson, MS, CTRS
• Melissa D. Johnson, CPNP
• Micah Johnson
• Patricia Ann Johnson, CMT
• Rebecca Johnson, LPCC, NCC
• Sarah Johnson
• Shaileen Johnson, FNP-C
• Stephanie M Johnson, NP

• Physician Assistant in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Physician Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.