Tyler Keith Johnson, APRN

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

1165582 Issued in TX

Practice address

6901 Medical Pkwy
Waco, TX 76712-7910

Phone

(254) 751-4180

NPI assigned

Jun 4, 2024

Sex

Male

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 TX

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, 2024

Medicare assignment

May accept Medicare assignment

Group practices

Legacy Urgent Care PAGroup PAC ID 3072679828, 157 clinicians

Providence Health AllianceGroup PAC ID 6305731068, 119 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ascension Providence Hospital, Waco, TX, CCN 450042

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Legacy Urgent Care, PA

  • Urgent Care Clinic/Center
  • Frisco, TX
  • NPI 1568622272
  Medicare reassignment Care Compare group NPD
• Providence Health Alliance

  • Specialist
  • Waco, TX
  • NPI 1932210838
  Medicare reassignment Care Compare group NPD
• Travis County Emergency Physicians PA

  • Emergency Medicine Physician
  • Austin, TX
  • NPI 1962440933
  Medicare reassignment NPD
• Providence Health Alliance

  • Rural Health Clinic/Center
  • Waco, TX
  • NPI 1336590462
  NPD

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

• Ascension Providence

  • General Acute Care Hospital
  • Waco, TX
  • NPI 1093708679
  Care Compare affiliation

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

{
    "created_epoch": "1717459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717459200000",
    "number": "1912748880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6901 MEDICAL PKWY",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767127910",
            "telephone_number": "254-751-4180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6901 MEDICAL PKWY",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767127910",
            "telephone_number": "254-751-4180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "TYLER",
        "middle_name": "KEITH",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-04",
        "last_updated": "2024-06-04",
        "certification_date": "2024-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1165582",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TX",
            "license": "1165582",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Renae Johnson, RPH
• Rita Johnson
• Starla K Johnson, FNP
• Susan Johnson, MD
• Trasaudia Johnson
• Joshua Kole Johnston
• Jason Lafayette Jolivet, DDS
• Jon M. Ellis, MD PA
• Jonathan G Wash DPM PA
• Alexandra Marie Jones Adesina

• Acute Care Nurse Practitioner in Waco, TX
• Providers in Waco, TX by specialty
• Acute Care Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2024; 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.