Jacob Lynn Johnson, DMD

Primary specialty

Military Health Care ProviderTaxonomy code 171000000X

License

34858 Issued in TX

Practice address

BLDG 1200, 149G W Hart St
Sheppard Afb, TX 76311-7631

Phone

(940) 676-4412

NPI assigned

Aug 22, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

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": "1503360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692489600000",
    "number": "1982120895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5021 TAFT BLVD APT 3302",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763085391",
            "telephone_number": "701-339-1678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BLDG 1200, 149G W HART ST",
            "city": "SHEPPARD AFB",
            "state": "TX",
            "postal_code": "763117631",
            "telephone_number": "940-676-4412"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2501 Capehart Rd",
            "address_purpose": "LOCATION",
            "city": "Bellevue",
            "state": "NE",
            "postal_code": "68123",
            "country_code": "US",
            "telephone_number": "402-232-0617",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JACOB",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-08-22",
        "last_updated": "2023-08-20",
        "certification_date": "2023-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2017020610",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "34858",
            "primary": false
        },
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": "TX",
            "license": "34858",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chau Ngoc Hoang, D.M.D
• Kay Ann Host, OTR
• Lacy Dee Hylton, DMD
• Alhaji M Jalloh
• Benjamin Keith Johnson, MD
• Larry Steven Johnson, M.S.W., L.C.S.W.
• Richard Lee Johnson, DDS, MD
• Raquel N. Karagines, APRN
• Michelle Rae Kastler, PT
• Robert Burrows Kelsey Jr., CRNA

• Military Health Care Provider in Sheppard Afb, TX
• Providers in Sheppard Afb, TX by specialty
• Military Health Care Provider in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 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.