MRS. TIALICKA BURGOS JOHNSON (NPI# 1891159463) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891159463 |
| Entity Type | Individual |
| Full Name | MRS. TIALICKA BURGOS JOHNSON |
| Credential | RNC-OB |
| Practice Address |
559 Vincent St Attn: 21 Mdos/sgog - Women's Health Peterson Afb CO 80914-1540 |
| Practice Telephone | 7195561179 |
| Practice Fax Number | 7195565435 |
| Mailing Telephone | 7195561179 |
| Mailing Fax Number | 7195565435 |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2018-12-06 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 163WX0003X |
Registered Nurse Specialization: Obstetric, Inpatient |
715790 | VA | Nursing Service Providers |
| N | 363LW0102X |
Nurse Practitioner Specialization: Women's Health |
24176717 | VA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
559 VINCENT ST ATTN: 21 MDOS/SGOG - WOMEN'S HEALTH |
| City | PETERSON AFB |
| State | CO |
| Zip Code | 80914-1540 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891797080 | Keith Andrew Baker | Family Medicine | 559 Vincent St, 21 Mdos/sgof -fam Hlth, Peterson Afb, CO 80914-1540 | 2005-06-01 |
| 1912475740 | Julian G Fiorina | Family Medicine | 559 Vincent St, Peterson Afb, CO 80914-1541 | 2018-11-09 |
| 1740776970 | Chelsea M. Cruz | Nurse Practitioner | 559 Vincent St, Peterson Afb, CO 80914-1541 | 2018-07-11 |
| 1376036665 | Emillie Claire Brandt | Dentist | 559 Vincent St, Peterson Afb, CO 80914-1541 | 2018-06-11 |
| 1164911053 | Renee Antoinette Smith | Dentist | 559 Vincent St, Peterson Afb, CO 80914-1540 | 2018-05-07 |
| 1720582448 | Cristina Cosner | Military Health Care Provider | 559 Vincent St, Attn: 21 Mdos/sgof - Flight Med, Peterson Afb, CO 80914-1540 | 2018-03-19 |
| 1619476504 | Clarissa Reno | Registered Nurse | 559 Vincent St, Peterson Afb, CO 80914-1541 | 2018-02-06 |
| 1114385747 | Jeffrey A Turner | Physical Therapist | 559 Vincent St, Attn: 21 Mdos/sgoy - Physical Therapy, Peterson Afb, CO 80914-1540 | 2016-02-10 |
| 1689046500 | Christine Chanmyaethu Tun | Physician Assistant | 559 Vincent St, Attn: 21 Mods/sgof - Family Health, Peterson Afb, CO 80914-1540 | 2015-10-30 |
| 1023489556 | Elizabeth Bator | Nurse Practitioner | 559 Vincent St, Attn: 21 Mdos/sgof - Family Practice, Peterson Afb, CO 80914-1540 | 2015-10-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356897250 | Kym Littlefield Whitaker | Nurse Practitioner | 110 Ent Avenue, Peterson Afb, CA 80914 | 2016-08-30 |
| 1114322583 | Jessica Charmaine Johnson | Social Worker | 559 Vincent St, Bldg 959, Attn: 21 Omrs/sgow, Peterson Afb, CO 80914 | 2014-10-28 |
| 1306916267 | John Frank Drozd | Psychologist | 21st Medical Group, 559 Vincent Street, Peterson Afb, CO 80914 | 2006-11-08 |
| 1801858865 | Moshe Mark Douglas Wexler | Clinical Neuropsychologist | 110 W. Ent Ave. Bldg 725, 21 Mdos/sgoh, Pafb, CO 80914 | 2006-04-05 |
| 1215902002 | William J Dickson | Dentist | Peterson Afb, Bld 950, Colorado Springs, CO 80914 | 2006-02-23 |
| 1740889773 | Brandon Dean Estes | Dental Hygienist | 1055 Stewart Ave, Bldg 2018, Apo, AA 80914 | 2020-10-21 |
| 1225458789 | Brianna Mcmurray | Family Medicine | 559 Vincent St Bldg 959, Colorado Springs, CO 80914 | 2014-04-23 |
| 1720406796 | Beth D Achterhoff | Physical Therapist | 559 Vincent St Bldg 959, Peterson Afb, CO 80914 | 2014-04-07 |
| 1275712895 | Monica Ibarra | Counselor | 559 Vincent St., Attn: 21 Mdos/sgow - Family Advocacy, Peterson Afb, CO 80914 | 2007-10-31 |
| 1912258591 | Ruth Angela Monsanto-williams | Nurse Practitioner | 110 West Ent Ave, Peterson Afb, 21st Medical Group, Colorado Springs, CO 80914-1540 | 2012-09-24 |
| Find all providers in zip 80914 | ||||
| Taxonomy Code | 163WX0003X |
| Grouping | Nursing Service Providers |
| Classification | Registered Nurse |
| Specialization | Obstetric, Inpatient |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669808325 | Socorro Alicia Herrera | Registered Nurse | 0405 Castle Creek Road, Suite 201, Aspen, CO 81611 | 2013-09-25 |
| 1457500167 | Lee Ann Jimenez | Registered Nurse | 9737 W 97th Pl, Westminster, CO 80021-6816 | 2008-09-17 |
| 1770192288 | Tracy J Hall | Registered Nurse | 4700 Lady Moon Dr, Fort Collins, CO 80528-4426 | 2020-07-30 |
| 1134750524 | Halley Everall | Registered Nurse | 2030 Mountain View Ave Ste 400, Longmont, CO 80501-3182 | 2020-02-04 |
| 1396375671 | Amanda Marie Fletcher | Registered Nurse | 1750 W Uintah St, Colorado Springs, CO 80904-2926 | 2020-01-25 |
| 1568962850 | Melissa Mitton | Registered Nurse | 225 S Union Blvd, Colorado Springs, CO 80910-3184 | 2018-02-14 |
| 1053839316 | Laurel Reisig | Registered Nurse | 2550 S Parker Rd Ste 400, Aurora, CO 80014-1677 | 2017-09-06 |
| 1124546734 | Glenda Irene Beyers | Registered Nurse | 8300 W. 38th Ave, Wheat Ridge, CO 80033 | 2017-09-03 |
| 1912456500 | David Holt | Registered Nurse | 580 Mohawk Dr, Boulder, CO 80303-3712 | 2016-09-24 |
| 1609323567 | Soo Roberts | Registered Nurse | 501 E Hampden Ave, Englewood, CO 80113-2702 | 2016-09-07 |
| Find all providers with the same taxonomy | ||||
| City | PETERSON AFB |
| Zip Code | 80914 |
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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.