Kendall Amanda Johnson, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA229637 Issued in OR

Practice address

4250 Mercantile Dr
Lake Oswego, OR 97035-2504

Phone

(503) 850-9940

NPI assigned

Sep 22, 2011

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

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": "1316649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788048000000",
    "number": "1962785212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4250 MERCANTILE DR STE B",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970352504",
            "telephone_number": "503-850-9940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4250 MERCANTILE DR",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970352504",
            "telephone_number": "503-850-9940"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2695 SW Cedar Hills Blvd Ste 140",
            "address_purpose": "LOCATION",
            "city": "Beaverton",
            "state": "OR",
            "postal_code": "970051415",
            "country_code": "US",
            "telephone_number": "503-850-9950",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KENDALL",
        "middle_name": "AMANDA",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-22",
        "last_updated": "2026-08-30",
        "certification_date": "2026-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OR",
            "license": "PA229637",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "HI",
            "license": "AMD-617",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deirdre Johnson, PHARM.D.
• Dona D Johnson
• Elizabeth Irwin Johnson
• Janice Johnson, LPC
• Keith Johnson, M.D.
• Shylo Johnson, LMT
• Tiamoya Johnson
• Joie de Vivre Counseling LLC
• Anastasia Jones, PSYD
• Barry Travis Jones, PH.D.

• Surgical Physician Assistant in Lake Oswego, OR
• Providers in Lake Oswego, OR by specialty
• Surgical Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2026; 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.