MS. KIMESHIA NICOLE JOHNSON (NPI# 1699928655) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699928655 |
| Entity Type | Individual |
| Full Name | MS. KIMESHIA NICOLE JOHNSON |
| Credential | FNP-C |
| Practice Address |
5414 S Broadway Ave Tyler TX 75703-1335 |
| Mailing Address |
Po Box 841656 Dallas TX 75284-1656 |
| Practice Telephone | 9035811601 |
| Practice Fax Number | 9035811638 |
| Mailing Telephone | 9035315000 |
| Enumeration Date | 2008-11-03 |
| Last Update Date | 2014-10-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | 679053 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
679053 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | BCBS BLUE | 0031BV | 01 |
| TX | RAIL ROAD | P01304442 | 01 |
| TX | TRICARE | 75-2616977-002 | 01 |
| TX | 323946902 | 05 | |
| TX | TRICARE | 75-2616977-001 | 01 |
| TX | RAIL ROAD | P01246227 | 01 |
| TX | BCBS BLUE | 00T71U | 01 |
| TX | TRICARE | 75-2616977-028 | 01 |
| TX | 323946901 | 05 | |
| TX | TRICARE | 75-0818167-022 | 01 |
| Street Address |
5414 S BROADWAY AVE |
| City | TYLER |
| State | TX |
| Zip Code | 75703-1335 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831189836 | Joseph Pistone | Emergency Medicine | 5414 S Broadway Ave, Tyler, TX 75703-1335 | 2005-10-21 |
| 1013483361 | Jeremy Michael Troyer | Registered Nurse | 5414 S Broadway Ave, Tyler, TX 75703-1335 | 2018-10-15 |
| 1770020778 | Melinda Hill | Nurse Practitioner | 5414 S Broadway Ave, Tyler, TX 75703-1335 | 2017-01-27 |
| 1467829440 | Jessica Atkinson | Physician Assistant | 5414 S Broadway Ave, Tyler, TX 75703-1335 | 2015-08-26 |
| 1659768737 | Jennifer Crayton | Nurse Practitioner | 5414 S Broadway Ave, Tyler, TX 75703-1335 | 2015-04-16 |
| 1609282664 | Heidi C Lehnig | Nurse Practitioner | 5414 S Broadway Ave, Tyler, TX 75703 | 2014-07-10 |
| 1093153645 | Michelle Parker | Family Medicine | 5414 S Broadway Ave, Tyler, TX 75703-1335 | 2013-06-05 |
| 1881997138 | Alma Delia Cadena | Physician Assistant | 5414 S Broadway Ave, Tyler, TX 75703-1335 | 2010-12-08 |
| 1750547741 | Maria Stanovic Karlson | Nurse Practitioner | 5414 S Broadway Ave, Tyler, TX 75703-1335 | 2008-07-30 |
| 1750549358 | Wendy L Freden | Physician Assistant | 5414 S Broadway Ave, Tyler, TX 75703-1335 | 2008-05-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174155477 | Choice Supportive Care Team Inc. | Family Medicine | 4293 Kinsey Drive, Tyler, TX 75703 | 2020-02-05 |
| 1770052532 | Refinery Chiropractic LLC | Chiropractor | 16637 Old Jacksonville Hwy, Suite D, Tyler, TX 75703 | 2018-11-21 |
| 1215419353 | Deidre Lynn Fergason | Occupational Therapy Assistant | 3505 Old Jacksonville Hwy, Tyler, TX 75703 | 2018-09-05 |
| 1710473681 | Justin Taylor Ross | Dentist | 8938 S Broadway Ave Ste 380, Tyler, TX 75703 | 2018-07-03 |
| 1457843450 | Adam Tyler Barnes, Dds of Texas II, Pllc | Dentist | 8938 South Broadway, Ste 480, Tyler, TX 75703 | 2018-06-05 |
| 1083106462 | Integrity Health | Internal Medicine | 5605 Old Bullard Rd Ste B, Tyler, TX 75703 | 2018-06-01 |
| 1427572544 | Cody Wayne Graham | Pharmacist | 5415 S. Broadway Ave., Tyler, TX 75703 | 2017-07-31 |
| 1750805941 | Roger Bryan Chapman | Nurse Practitioner | 6115 New Copeland Rd, Tyler, TX 75703 | 2017-07-28 |
| 1427570084 | Darah Lynne Dahlem | Speech-Language Pathologist | 401 E. Front Street Ste 123, Tyler, TX 75703 | 2017-07-14 |
| 1194267468 | Herman Lester Hampton Jr. | Surgery | 5803 Regents Row, Tyler, TX 75703 | 2016-11-17 |
| Find all providers in zip 75703 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841830601 | David Clay Mcintyre | Nurse Practitioner | 7924 S Broadway Ave Ste 900, Tyler, TX 75703-5252 | 2020-01-09 |
| 1750805941 | Roger Bryan Chapman | Nurse Practitioner | 6115 New Copeland Rd, Tyler, TX 75703 | 2017-07-28 |
| 1477925600 | Brenda Leath Goings | Nurse Practitioner | 703 S Fleishel Ave # 5000, Tyler, TX 75701 | 2015-10-27 |
| 1750708368 | Crossway Family Health Center Pllc | Nurse Practitioner | 6004 South Broadway, Tyler, TX 75703-4424 | 2014-03-20 |
| 1780952580 | Loretta Eve Wilson | Nurse Practitioner | 700 Olympic Plaza Cir Ste 904, Tyler, TX 75701-1958 | 2011-12-07 |
| 1558442376 | Christina Danielle Barnes | Nurse Practitioner | 800 E Dawson St - Hospitalists, Tyler, TX 75701 | 2006-10-18 |
| 1164406773 | Gayle Pegler Varnell | Nurse Practitioner | 3900 University Blvd, Tyler, TX 75799-0001 | 2005-12-06 |
| 1922080076 | Kerry Scruggs | Nurse Practitioner | 3310 Patriot Dr, Tyler, TX 75701-6606 | 2005-11-15 |
| 1003414525 | Abram Ambriz | Nurse Practitioner | 2608 Mcdonald Rd, Tyler, TX 75701-5934 | 2020-10-16 |
| 1396350039 | Lorna Casey Blakney | Nurse Practitioner | 1305 Doctors Dr, Tyler, TX 75701-2263 | 2020-09-10 |
| Find all providers in TYLER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.