Susan McCambly Johnson, PHYSICIAN ASSISTANT

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

531 Issued in AK

Practice address

4100 Lake Otis Pkwy
Ste. 322
Anchorage, AK 99508-5222

Phone

(907) 562-1234

Fax

(907) 561-8550

NPI assigned

Dec 19, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ms. Susan McCambly Fly Former name

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": "1166486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1972667749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2750 GREENSCREEK CIR",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "99516",
            "telephone_number": "907-522-0167",
            "fax_number": "907-646-2573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 LAKE OTIS PKWY",
            "address_2": "STE. 322",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995085222",
            "telephone_number": "907-562-1234",
            "fax_number": "907-561-8550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "SUSAN",
        "middle_name": "MCCAMBLY",
        "name_prefix": "Mrs.",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-19",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AK",
            "license": "531",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATELIC",
            "identifier": "531",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "FLY",
            "middle_name": "MCCAMBLY",
            "prefix": "MS.",
            "credential": "RN FORMERLY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Shontale Denise Johnson, LCSW
• Skye Johnson
• Staci L Johnson, APRN
• Steven Johnson, MD
• Susan Harding Johnson, DPT
• Taylor Johnson
• Theresa Johnson
• Zachary Johnson, PA-C
• Alyssa Johnston
• Harold L Johnston, MD

• Physician Assistant in Anchorage, AK
• Providers in Anchorage, AK by specialty
• Physician Assistant in Alaska

• 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.