Ebony Talise Johnson, BSN-RN

Primary specialty

Home Infusion AgencyTaxonomy code 251F00000X

License

041418831 Issued in IL

Practice address

1216 West 97TH Place
Chicago, IL 60643

Phone

(708) 543-0632

NPI assigned

Feb 11, 2025

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 7

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1739232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739232000000",
    "number": "1922813401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1216 W 97TH PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606431420",
            "telephone_number": "708-543-0632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1216 WEST 97TH PLACE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60643",
            "telephone_number": "708-543-0632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "EBONY",
        "middle_name": "TALISE",
        "name_prefix": "Mrs.",
        "credential": "BSN-RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-02-11",
        "last_updated": "2025-02-11",
        "certification_date": "2025-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WS0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, School",
            "state": "IL",
            "license": "041418831",
            "primary": false
        },
        {
            "code": "251F00000X",
            "taxonomy_group": "",
            "desc": "Home Infusion",
            "state": "IN",
            "license": "28293616A",
            "primary": false
        },
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": "IL",
            "license": "041418831",
            "primary": false
        },
        {
            "code": "251F00000X",
            "taxonomy_group": "",
            "desc": "Home Infusion",
            "state": "IL",
            "license": "041418831",
            "primary": true
        },
        {
            "code": "163WC1600X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Continuing Education/Staff Development",
            "state": "IL",
            "license": "041418831",
            "primary": false
        },
        {
            "code": "163WI0500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Infusion Therapy",
            "state": "IN",
            "license": "28293616A",
            "primary": false
        },
        {
            "code": "163WI0500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Infusion Therapy",
            "state": "IL",
            "license": "041418831",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Derick Johnson, APRN
• Derron Johnson Jr., LCPC
• Dominique Latrice Johnson, DO
• Donna Johnson, PHLEBOTOMIST
• Dwayne Arra Johnson Sr., LCSW
• Edlicia Johnson, AMFT
• Elizabeth Johnson
• Elizabeth Anne Johnson, DTH
• Elli Clare Johnson, MD
• Emilie Johnson, MD

• Home Infusion Agency in Chicago, IL
• Providers in Chicago, IL by specialty
• Home Infusion Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2025; 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.