NICOLE LYNN JOHNSON (NPI# 1578951240) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578951240 |
| Entity Type | Individual |
| Full Name | NICOLE LYNN JOHNSON |
| Credential | CFNP |
| Practice Address |
15476 Dedeaux Rd Gulfport MS 39503-2637 |
| Mailing Address |
6300 E Lake Blvd Vancleave MS 39565-6770 |
| Practice Telephone | 2282302663 |
| Practice Fax Number | 2286793038 |
| Mailing Telephone | 2282302663 |
| Mailing Fax Number | 2282061192 |
| Enumeration Date | 2015-01-05 |
| Last Update Date | 2017-04-19 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | R878829 | MS | Nursing Service Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
R878829 | MS | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 05855337 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578188991 | Nicole Lynn Johnson | Occupational Therapist | 2616 Overlake Ave, Orlando, FL 32806-7353 | 2020-06-11 |
| 1861015893 | Nicole Johnson | Registered Nurse | 5794 193rd St W, Farmington, MN 55024-9579 | 2020-05-26 |
| 1255969705 | Nicole Rochshel Johnson | Home Health Aide | 4045 Regina Coeli Ct, Marrero, LA 70072-6354 | 2020-03-31 |
| 1942859038 | Nicole Johnson | Developmental Therapist | 7355 13th Ave Nw, Seattle, WA 98117-5306 | 2019-09-10 |
| 1053974360 | Nicole Johnson | Student in an Organized Health Care Education/Training Program | 28741 Appletree, Mission Viejo, CA 92692-1088 | 2019-04-22 |
| 1750868212 | Nicole Marie Johnson | Psychologist | 200 E Travelers Trl Ste 205, Burnsville, MN 55337-4191 | 2018-07-26 |
| 1295228310 | Nicole Marie Johnson | Technician | 2807 Douglass Pl Se, Washington, DC 20020-4420 | 2018-06-13 |
| 1922512078 | Nicole Johnson | Occupational Therapy Assistant | 1498 Port Malabar Blvd Ne, Palm Bay, FL 32905-5240 | 2017-11-28 |
| 1083133490 | Nicole Rebecca Liu Johnson | Psychologist | 20826 2nd Ave W, Lynnwood, WA 98036-7256 | 2017-09-18 |
| 1871010967 | Nicole Lynne Johnson | Counselor | 800 Gallia Street Suite 600, Portsmouth, OH 45662 | 2017-08-29 |
| Street Address |
15476 DEDEAUX RD |
| City | GULFPORT |
| State | MS |
| Zip Code | 39503-2637 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558462218 | Eric J Graham | Specialist | 15476 Dedeaux Rd, Gulfport, MS 39503-2637 | 2006-09-26 |
| 1669006102 | Alyssa Morgan Zelenka | Occupational Therapist | 15476 Dedeaux Rd, Gulfport, MS 39503-2637 | 2020-02-24 |
| 1427507037 | Ophelia Abrahams | Occupational Therapist | 15476 Dedeaux Rd, Suite B, Gulfport, MS 39503-2637 | 2016-09-23 |
| 1417340514 | Denese H Dapito | Occupational Therapist | 15476 Dedeaux Rd, Gulfport, MS 39503-2637 | 2015-03-12 |
| 1932522281 | Jason W Caswell | Physician Assistant | 15476 Dedeaux Rd, Gulfport, MS 39503-2637 | 2014-01-22 |
| 1609163682 | Joseph Tyler Cox | Orthopaedic Surgery | 15476 Dedeaux Rd, Gulfport, MS 39503 | 2011-06-29 |
| 1689804668 | Bienville Orthopaedic Specialists, LLC | Durable Medical Equipment & Medical Supplies | 15476 Dedeaux Rd, Suite B, Gulfport, MS 39503-2637 | 2009-07-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013515451 | Gulf Coast Neurospa, LLC | Psychiatry & Neurology | 8845 Lorraine Road, Gulfport, MS 39503 | 2020-10-16 |
| 1447865985 | Nicholas Wyrosdick | Physical Therapist | 12261 Us 49 #1, Gulfport, MS 39503 | 2020-09-11 |
| 1750935169 | Ladner Roy Drugs, LLC. | Pharmacy | 12261 Us 49 Suite 16, Gulfport, MS 39503 | 2019-07-25 |
| 1528559440 | Alexander Therapy Services, LLC | Clinic/Center | 15465 Oak Ln Ste 100c, Gulfport, MS 39503 | 2018-05-25 |
| 1750879003 | Heather Lynn Theisen | Nurse Practitioner | 15190 Community Rd Ste 330, Gulfport, MS 39503 | 2018-04-23 |
| 1083101216 | Gulf Coast Mental Health Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 15094 County Barn Road, Gulfport, MS 39503 | 2018-04-13 |
| 1306343173 | Dr. Raymond Monsour Scurfield, LLC | Community/Behavioral Health | 15465 Oak Lane Ste 100-g, Gulfport, MS 39503 | 2018-04-09 |
| 1952817157 | Mary Beth Welch | Behavioral Analyst | 9230 Old Lorraine Rd, Gulfport, MS 39503 | 2017-12-26 |
| 1831603257 | Beach View Family Dental, Pllc | Dentist | 9072 Lorraine Road, Gulfport, MS 39503 | 2017-11-21 |
| 1437677721 | Mary Stephens Ruffin | Social Worker | 11262 Creek Dr, Gulfport, MS 39503 | 2017-09-07 |
| Find all providers in zip 39503 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881293371 | Hanna Fernandez | Nurse Practitioner | 14225 Dedeaux Rd, Gulfport, MS 39503-3369 | 2020-10-26 |
| 1063033108 | Tiffany Reffit | Nurse Practitioner | 4300 15th St Ste B, Gulfport, MS 39501-2524 | 2020-04-29 |
| 1669002333 | Lauren Renee Meaut | Nurse Practitioner | 1391 Broad Ave Ste 320, Gulfport, MS 39501-2419 | 2020-01-22 |
| 1871132076 | Meddol Regina Mccray | Nurse Practitioner | 2070 30th St, Gulfport, MS 39501-6055 | 2020-01-06 |
| 1154968394 | Carolyn Marie Peters | Nurse Practitioner | 10236 Little Gem Dr, Gulfport, MS 39503-8357 | 2019-12-06 |
| 1588121578 | Mai Thi Tran | Nurse Practitioner | 1404 44th Ave, Gulfport, MS 39501-2554 | 2019-02-26 |
| 1861957631 | Tomika Marie Dedeaux | Nurse Practitioner | 283 Debuys Rd, Gulfport, MS 39507-2800 | 2019-02-06 |
| 1861963993 | Carol Leigh Anne Thompson | Nurse Practitioner | 2449 Summerwood, Gulfport, MS 39507-2216 | 2018-12-16 |
| 1730679739 | Erica Lynn Turan | Nurse Practitioner | 3310 17th St, Gulfport, MS 39501-3915 | 2018-05-15 |
| 1740709773 | Justine Hunt | Nurse Practitioner | 8950 Lorraine Rd Ste B, Gulfport, MS 39503-4183 | 2017-09-11 |
| Find all providers in GULFPORT | ||||
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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.