Charla Johansen, NURSE PRACTITIONER

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

234691 Issued in AZ

Practice address

95 Soldiers Pass Rd Ste B1
Sedona, AZ 86336-4712

Phone

(928) 204-4900

NPI assigned

Oct 24, 2006

Last updated

Sep 26, 2022By the provider in NPPES

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

Enrolled in AZ

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Charla Johansen- Nurse Practitioner

  • Nurse Practitioner
  • Sedona, AZ
  • NPI 1477279412
  Authorized official Same address or phone
• Avenir Ventures, L.L.C.

  dba Comfort Care Medical Group

  • Physician Assistant
  • Pensacola, FL
  • NPI 1568723898

  Nurse Practitioner

  NPD (past)
• Avenir Ventures, L.L.C.

  dba Amedisys Palliative Care

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Franklinton, NC
  • NPI 1629967138
  NPD (past)
• Npoc LLC

  • Family Nurse Practitioner
  • Pensacola, FL
  • NPI 1841732971
  NPD (past)

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664150400000",
    "number": "1982787560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 SOLDIERS PASS RD STE B1",
            "city": "SEDONA",
            "state": "AZ",
            "postal_code": "863364712",
            "telephone_number": "928-204-4900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95 SOLDIERS PASS RD STE B1",
            "city": "SEDONA",
            "state": "AZ",
            "postal_code": "863364712",
            "telephone_number": "928-204-4900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1215 N Beaver St",
            "address_purpose": "LOCATION",
            "city": "Flagstaff",
            "state": "AZ",
            "postal_code": "860013126",
            "country_code": "US",
            "telephone_number": "928-773-2200",
            "fax_number": "928-773-2300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4511 N Davis Hwy",
            "address_2": "Suite I-C",
            "address_purpose": "LOCATION",
            "city": "Pensacola",
            "state": "FL",
            "postal_code": "325032720",
            "country_code": "US",
            "telephone_number": "850-476-9088",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHANSEN",
        "first_name": "CHARLA",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-24",
        "last_updated": "2022-09-26",
        "certification_date": "2022-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "AZ",
            "license": "234691",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "FL",
            "license": "3234612",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ioana Irime, M.D.
• Kendra Ivy, OD
• Elaine M Jackson, MS CCC SLP
• Janalene C McRae PLLC
• Janne M Lynch DDS PLLC
• Steven M. Johnson, M.D.
• Kachina Point Rehabilitation Hospital LLC
• Nicholas C Kanaan, M.D.
• Linda S. Kaplan, APRN
• Kathy J O'Connor MD PA

• Gerontology Nurse Practitioner in Sedona, AZ
• Providers in Sedona, AZ by specialty
• Gerontology Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.