Individual provider Active NPI

Kristina Elane Johnson, NP

  • Nurse Practitioner
  • Tyler, TX
National Provider Identifier
1962052514
Registry record updated Sep 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AP140053 Issued in TX
Practice address
2608 McDonald Rd
Tyler, TX 75701-5934
Phone
(903) 595-5514
Fax
(903) 262-3707
NPI assigned
Sep 16, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X AP140053 TX Primary

Addresses

Primary practice location

2608 McDonald Rd
Tyler, TX 75701-5934

Mailing address

PO Box 130549
Tyler, TX 75713-0549
Phone (903) 579-3931

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20191016001442 TX Practitioner - Nurse Practitioner 3274864640 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Etmc Physician Group, Inc.Group PAC ID 4486915600, 375 clinicians

Practice addresses (Care Compare)

1000 S Beckham Ave
Tyler, TX 75701-1908
Phone (903) 590-5611

18118 FM 344
Flint, TX 75762-6010
Phone (903) 825-3292

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP140053TXMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Etmc Physician Group Inc. CurrentSince Sep 1, 2019 Accepting new patients
Etmc Physician Group Inc. CurrentSince Sep 1, 2019 Accepting new patients
Jacksonville Hospital LLC Past Accepting new patients
Carthage Hospital, LLC Past Accepting new patients
Henderson Memorial Hospital Past Accepting new patients
Starks Medical PastSince Sep 25, 2019 Accepting new patients
Pittsburg Hospital LLC Past Accepting new patients

Locations

2000 S Palestine St
Athens, TX 75751
Phone (903) 675-2216

704 Davis St
Carthage, TX 75633
Phone (903) 694-4824

702 Davis St
Carthage, TX 75633
Phone (903) 693-3841

18118 FM 344 W
Flint, TX 75762
Phone (903) 825-3292

300 Wilson St
Henderson, TX 75652
Phone (903) 655-6536

203 Nacogdoches St
Ste 240
Jacksonville, TX 75766
Phone (903) 541-5452

2701 US Highway 271 N
Pittsburg, TX 75686
Phone (903) 946-5000

2608 McDonald Rd
Tyler, TX 75701
Phone 903595551487262

Interoperability endpoints

  • Direct secure messaging: kjohnson355646@ahs.direct-ci.com

Organizations & group practices 7

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1568592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568592000000",
    "number": "1962052514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 130549",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757130549",
            "telephone_number": "903-579-3931",
            "fax_number": "903-509-5835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2608 MCDONALD RD",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757015934",
            "telephone_number": "903-595-5514",
            "fax_number": "903-262-3707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KRISTINA",
        "middle_name": "ELANE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-16",
        "last_updated": "2019-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "AP140053",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.