Rickie E. Johnson, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

A10226 Issued in LA

Practice address

7238 6TH St BLDG 249
Hill Air Force Base, UT 84056-5213

Phone

(801) 777-1155

Fax

(801) 775-6884

NPI assigned

Dec 28, 2005

Sex

Male

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Moss Street Medical Clinic Inc

  • Medical Physician Assistant
  • Lafayette, LA
  • NPI 1417085192
  NPD Authorized official

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

{
    "created_epoch": "1135728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523232000000",
    "number": "1982681292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 BROADWAY APT C214",
            "city": "FARMINGTON",
            "state": "UT",
            "postal_code": "840255657",
            "telephone_number": "337-278-8826",
            "fax_number": "801-775-6884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7238 6TH ST BLDG 249",
            "city": "HILL AIR FORCE BASE",
            "state": "UT",
            "postal_code": "840565213",
            "telephone_number": "801-777-1155",
            "fax_number": "801-775-6884"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "990 Napoleon Ave",
            "address_purpose": "LOCATION",
            "city": "Sunset",
            "state": "LA",
            "postal_code": "705846100",
            "country_code": "US",
            "telephone_number": "337-662-7290",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "RICKIE",
        "middle_name": "E.",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-28",
        "last_updated": "2018-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "LA",
            "license": "A10226",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1627755",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lance Cressall
• Michael L Gorder
• Alan Lamar Hall, RPH
• Gary Heaston, PA-C
• Jonathan Andrew Hess, MD
• Keith Mele, PHARM.D
• Stephen Braun Tueller, PH.D.
• Michelle Ybarra, LCSW

• Physician Assistant in Hill Air Force Base, UT
• Providers in Hill Air Force Base, UT by specialty
• Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2018; 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.