NATHAN PATRICK JOHNSON (NPI# 1952754442) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952754442 |
| Entity Type | Individual |
| Full Name | NATHAN PATRICK JOHNSON |
| Credential | PMHNP-BC |
| Practice Address |
4035 12th St Cutoff Se Ste 120 Salem OR 97302 |
| Mailing Address |
Po Box 12926 Salem OR 97309-0926 |
| Practice Telephone | 9713049306 |
| Practice Fax Number | 5039266624 |
| Mailing Telephone | 9713049306 |
| Mailing Fax Number | 5039266624 |
| Enumeration Date | 2016-07-19 |
| Last Update Date | 2019-07-25 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | 209338 | TN | Nursing Service Providers |
| N | 163WP0808X |
Registered Nurse Specialization: Psych/Mental Health |
201701389RN | OR | Nursing Service Providers |
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
201701390NPPP | OR | Allopathic & Osteopathic Physicians |
| N | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
0000022011 | TN | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
201701390NP-PP | OR | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | PECO, NPPES | 1952754442 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1249 Fairview Ave Se, Salem, OR 97302 | 9713049306 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609379494 | Nathan Johnson | Specialist/Technologist | 15958 Winans St, Grand Haven, MI 49417-9636 | 2018-03-17 |
| 1104264027 | Nathan Deshay Johnson | Behavioral Analyst | 2200 North. Torrey Pines Dr., Las Vegas, NV 89108-6509 | 2013-06-13 |
| 1467773341 | Nathan Ray Johnson | Massage Therapist | 2713 W Sligh Ave, Tampa, FL 33614-4343 | 2010-06-15 |
| 1841510245 | Nathan Samuel Johnson | Anesthesiology | 6009 Ralston Ave, Indianapolis, IN 46220-2353 | 2010-06-08 |
| 1336467406 | Nathan Warren Johnson | Dentist | 1451 River Walk Cir, Birmingham, AL 35216-6811 | 2010-05-13 |
| 1104088129 | Nathan C. Johnson | Dentist | 143 E 200 S, Springville, UT 84663-1915 | 2008-07-01 |
| 1447443908 | Nathan Richard Johnson | Physical Therapist | 2118 W Race Ave, Chicago, IL 60612-1510 | 2007-08-19 |
| 1427130368 | Nathan D Johnson | Optometrist | 5990 Santo Rd, San Diego, CA 92124-1192 | 2006-10-19 |
| 1801496005 | Nathan William Johnson | Occupational Therapist | 915 E 1st St, Duluth, MN 55805-2107 | 2020-10-27 |
| 1063024891 | Nathan Allen Johnson | Nurse Practitioner | 1500 E Medical Center Dr, Ann Arbor, MI 48109-5000 | 2020-08-22 |
| Street Address |
4035 12TH ST CUTOFF SE STE 120 |
| City | SALEM |
| State | OR |
| Zip Code | 97302 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427527886 | Stasis Psychiatry, LLC | Psychiatry & Neurology | 4035 12th St Cutoff Se Ste 120, Salem, OR 97302-1754 | 2018-11-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952954679 | Eric Anthony Bohm | Pharmacist | 2757 22nd St. Se, Salem, OR 97302 | 2019-07-22 |
| 1598223737 | Michael Robert Martini | Counselor | 960 Liberty Rd Se Suite 120, Salem, OR 97302 | 2019-03-06 |
| 1659857480 | Avalina Pharmacy Inc | Pharmacy | 3507 Commercial St Se, Salem, OR 97302 | 2018-07-16 |
| 1649762733 | Joseph Bochsler | Physical Therapist | 3220 Liberty Rd. S., Salem, OR 97302 | 2018-06-04 |
| 1922533652 | Brianne Elizabeth Sischo | Licensed Practical Nurse | 3871 Fairview Industrial Dr. Se Ste, 150, Salem, OR 97302 | 2017-05-01 |
| 1851825566 | Modern Nose Clinic LLC | Otolaryngology | 340 Vista Ave Se, Ste 100, Salem, OR 97302 | 2017-04-19 |
| 1720529803 | Nicholas Forsberg | Massage Therapist | 126 Mize Rd S, Salem, OR 97302 | 2017-03-09 |
| 1437691078 | Kimo Mahi | Specialist/Technologist, Other | 2373 Kuebler Rd. S, Salem, OR 97302 | 2016-11-14 |
| 1588113278 | New Life Family Medicine LLC | Clinic/Center | 842 Commercial Street Ne, Salem, OR 97302 | 2016-09-23 |
| 1073060117 | Susan Morag Robnett | Counselor | 912 Fir Street South, Salem, OR 97302 | 2016-09-07 |
| Find all providers in zip 97302 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366073421 | Aspire Telepsychiatry | Nurse Practitioner | 1910 24th St Ne, Salem, OR 97301-8150 | 2020-01-28 |
| 1962058362 | Kimberly Diane Nelson | Nurse Practitioner | 35 Congress St Ste 225, Salem, MA 01970-5529 | 2019-08-13 |
| 1861970972 | Norrine Mcnelley | Nurse Practitioner | 25 Beechwood Rd, Salem, NH 03079 | 2018-07-31 |
| 1235493495 | Sarah Frances Robbins | Nurse Practitioner | 1595 Roosevelt St Ne, Salem, OR 97301 | 2012-07-02 |
| 1700155538 | Vanessa Anne Underwood | Nurse Practitioner | 1595 Cottage St Ne, Salem, OR 97301-7123 | 2011-12-22 |
| 1134364524 | Sharon Vaden Karn | Nurse Practitioner | 870 Commercial St Se, Salem, OR 97302-4108 | 2008-12-12 |
| 1861605768 | Barbara S Miller | Nurse Practitioner | Odoc, 2605 State St, Salem, OR 97310-0001 | 2007-05-07 |
| 1538225818 | Aleyna Cecile Reed | Nurse Practitioner | 685 Cottage St Ne, Salem, OR 97301-2419 | 2006-12-29 |
| 1407915408 | James Ben Newman | Nurse Practitioner | 1235 Woodrow St Ne, Salem, OR 97303-3214 | 2006-12-06 |
| 1033285713 | Rita Herlong | Nurse Practitioner | 4035 12th Street Cutoff, Suit120, Salem, OR 97302-1764 | 2006-11-27 |
| Find all providers in SALEM | ||||
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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.