DR. KENDRICK DEWAYNE JOHNSON


Address: Osf St Francis Medical Ctr, 530 N.e. Glen Oak Ave, Peoria, IL 61637-0001
Phone: 3096552642

DR. KENDRICK DEWAYNE JOHNSON (NPI# 1790122141) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1790122141
Entity Type Individual
Full Name DR. KENDRICK DEWAYNE JOHNSON
Credential M.D.
Practice Address Osf St Francis Medical Ctr
530 N.e. Glen Oak Ave
Peoria
IL 61637-0001
Mailing Address 9045 Kingston Rd
Apt 2906
Shreveport
LA 71118-3466
Practice Telephone 3096552642
Mailing Telephone 3184269287
Enumeration Date 2013-05-24
Last Update Date 2013-05-24
Gender Code M
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207T00000X Neurological Surgery 125.063144 IL Allopathic & Osteopathic Physicians

Other Providers KENDRICK JOHNSON

NPI Name Taxonomy Address Enumeration
1558700054 Kendrick O Johnson Family Medicine 2000 W Bethany Home Rd, Phoenix, AZ 85015-2443 2013-06-18
1275971715 Kendrick C Johnson Nurse Anesthetist, Certified Registered 13737 Noel Rd Ste 1400, Dallas, TX 75240-2004 2013-06-06
1780720979 Kendrick Millard Johnson Emergency Medicine 1650 Creekside Dr, Folsom, CA 95630-3400 2007-01-29

Office Location

Street Address OSF ST FRANCIS MEDICAL CTR
530 N.E. GLEN OAK AVE
City PEORIA
State IL
Zip Code 61637-0001

Providers in the same location

NPI Name Taxonomy Address Enumeration
1386659241 Central Illinois Radiological Associates, Ltd. Radiology Osf St Francis Medical Ctr, 530 N.e. Glen Oak, Peoria, IL 61636-0001 2006-07-29
1336526524 Ammar Ahmed Student in an Organized Health Care Education/Training Program Osf St Francis Medical Ctr, 530 Ne Glen Oak Ave, Sfnb 2624, Peoria, IL 61637-0001 2015-04-27
1528477015 Dianne Maria Endress Nurse Practitioner Osf St Francis Medical Ctr, 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 2014-08-08
1295173789 Paul Miles Macmahon Neurological Surgery Osf St Francis Medical Ctr, 530 N.e. Glen Oak Ave, Peoria, IL 61637-0001 2013-06-06

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1780200865 Kuang Chuen Liu Pediatrics 530 Ne Glen Oak Ave, Peoria, Peoria, IL 61637 2020-06-24
1174184527 Manisha Tharoor Student in an Organized Health Care Education/Training Program 530 N.e Glen Oak Ave, Peoria, IL 61637 2019-06-26
1609436724 Sriviji Senthil Kumaran Student in an Organized Health Care Education/Training Program 530. N.e Glen Oak Ave., Peoria, IL 61637 2019-06-20
1780240929 Abuzar Ali Asif Student in an Organized Health Care Education/Training Program 530 N. E. Glen Oak Ave., Peoria, IL 61637 2019-05-14
1518328665 Jenna Bishop Dietitian, Registered 600 Ne Water Street, Peoria, IL 61637 2016-03-17
1194133850 Ashish Kumar Roy Internal Medicine 530 N.e. Glen Oak Ave, Peoria, IL 61637 2014-07-25
1265720510 Reuben Antony Pediatrics 530 Ne Glen Oak Ave., C/o Ms Suzy Lewellen, Peoria, IL 61637 2011-07-20
1366673436 Joseph William Hauter Emergency Medicine 830 Ne Glen Oak Ave, Peoria, IL 61637 2009-08-06
1437380748 Jeremy R Monroe Emergency Medicine 530 Glen Oak, Osf St Francis Medical Center, Peoria, IL 61637 2009-08-04
1326244682 Maria S. Parr Psychiatry & Neurology Osf Saint Francis Medical Center, 530 N.e.glen Oak Ave., Peoria, FL 61637 2007-06-25
Find all providers in zip 61637

Taxonomy Information

Taxonomy Code 207T00000X
Grouping Allopathic & Osteopathic Physicians
Classification Neurological Surgery

Taxonomy Definition

A neurological surgeon provides the operative and non-operative management (i.e., prevention, diagnosis, evaluation, treatment, critical care, and rehabilitation) of disorders of the central, peripheral, and autonomic nervous systems, including their supporting structures and vascular supply; the evaluation and treatment of pathological processes which modify function or activity of the nervous system; and the operative and non-operative management of pain. A neurological surgeon treats patients with disorders of the nervous system; disorders of the brain, meninges, skull, and their blood supply, including the extracranial carotid and vertebral arteries; disorders of the pituitary gland; disorders of the spinal cord, meninges, and vertebral column, including those which may require treatment by spinal fusion or instrumentation; and disorders of the cranial and spinal nerves throughout their distribution.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Neurological Surgery, 2007. http://www.abns.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Neurological Surgery.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1003861634 Patrick William Elwood Neurological Surgery 719 N William Kumpf Blvd, Suite 100, Peoria, IL 61605 2006-05-23
1295185056 Thomas Morison Russell Neurological Surgery 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 2016-06-13
1700235280 Nolan Winslow Neurological Surgery 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 2016-06-06
1790167559 Daniel Vollhaber Neurological Surgery 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 2015-06-29
1053793315 Max Kahn Neurological Surgery 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 2015-06-23
1720493000 Sujit Bhimireddy Neurological Surgery 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 2014-06-25
1295173789 Paul Miles Macmahon Neurological Surgery Osf St Francis Medical Ctr, 530 N.e. Glen Oak Ave, Peoria, IL 61637-0001 2013-06-06
1326485921 Illinois Neuroscience Institute Neurological Surgery 100 Ne Randolph Ave, Peoria, IL 61606-1919 2013-05-23
1043506942 Derek Martinez Neurological Surgery 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 2011-06-20
1467765040 Andres L Maldonado Neurological Surgery 200 E Pennsylvania Ave, Peoria, IL 61603-3089 2010-07-23
Find all providers in PEORIA

Competitor

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City PEORIA
Zip Code 61637

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Dataset Information

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.

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