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Deactivated NPI 1770124687 Deactivated / Inactive NPI Male Practitioner

Kevin Johnson , MSN, APRN, FNP-C

Nurse Practitioner • Provo, UT

✓ Accepts Medicare Assignment
⚠️

Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Kevin Johnson has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date October 02, 2019
NPI Deactivation Date December 11, 2019
Total Practice Duration ~1 Years of Practice (2019 – 2019)

Professional Overview & Biography Verified Profile Summary

Kevin Johnson, MSN, APRN, FNP-C was a registered Nurse Practitioner practicing in Provo, UT. Throughout an active medical career spanning 1 years, Kevin Johnson provided care at the practice location at 1055 N 500 W STE 205 until profile deactivation on 2019-12-11.

Kevin Johnson was affiliated with Ihc Health Services Inc and accepted Medicare assignment.

Practice Location & Contact Primary Location

Practice Address

1055 N 500 W Ste 205

Provo, UT 846043305

Telephone 8014298095
Associated Practice Facility / Clinic
🏢 No Roll Up Timpanogos Llc Facility NPI 1831153840

Medicare Profile & Education

Medical School

Other

Graduation Year

2019

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Nurse Practitioner in Provo, UT

Experienced Practitioner (5-10 Yrs)
Practitioner Clinical Experience
7 Yrs -2.2 yrs vs City Avg
City Avg: 9.2 Yrs
State Avg: 8.4 Yrs
Regional Practice Density
99 Specialists

Practicing in Provo, UT (1143 Statewide)

Telehealth Adoption Rate
31.3% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Johnson (7 Years) 7 Yrs
Provo Specialty Average (9.2 Years) 9.2 Yrs

Medical Specialties & State Licenses

CMS Verified: 2020-04-22
Nurse Practitioner Primary Specialty

NUCC Taxonomy Code: 363L00000X

State License UT 8262328-4405

(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.

Hospital & Practice Group Affiliations

Ihc Health Services Inc

1380 E Medical Ctr Dr, St George, UT 847902123

Phone: 4352512740

Secondary Practice Locations

1926 W Pleasant Grove Blvd

Pleasant Grove, UT 840623317

Phone: 8018991244

621 E 12300 S

Draper, UT 840209854

Phone: 3853374711

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

8 Associated Practitioners
Rosanne Oliver , FNP

Nurse Practitioner - Family

NPI 1073903720

Family Nurse Practitioner

Elizabeth Avery , PA

Physician Assistant

NPI 1134828965

Physician Assistant

Dr. Steven Bigler , MD

Obstetrics & Gynecology - Gynecology

NPI 1205894649

Doctor of Medicine (M.D.)

Dr. Mohammed Nizam , MD

Internal Medicine - Endocrinology, Diabetes & Metabolism

NPI 1326203514

Doctor of Medicine (M.D.)

Elizabeth Mahoney , PA

Physician Assistant

NPI 1417610890

Physician Assistant

Dr. Malgorzata Hanczyc , MD

Internal Medicine - Rheumatology

NPI 1467765735

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

11 Historical Events
📍
Updated Practice Location January 15, 2020

Registered at 1055 N 500 W STE 205, PROVO, UT 846043305 (Tel: 8014298095)

📍
Updated Business Mailing Address January 15, 2020

Registered at 1055 N 500 W, ATTN: CREDENTIALING, PROVO, UT 846043305 (Tel: 8013548225)

👤
Provider Name / Credentials Updated January 15, 2020

Recorded as KEVIN JOHNSON, MSN, APRN, FNP-C

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) January 15, 2020

Nurse Practitioner (License #8262328-4405 in UT)

⚠️
NPI Profile Deactivated December 11, 2019

Record deactivated on December 11, 2019

NPI Profile Active October 02, 2019

NPI status registered as active in NPPES database

📍
Updated Practice Location October 02, 2019

Registered at 621 E 12300 S, DRAPER, UT 840209854 (Tel: 3853374711)

📍
Updated Business Mailing Address October 02, 2019

Registered at 621 E 12300 S, DRAPER, UT 840209854 (Tel: 3853374711)

👤
Provider Name / Credentials Updated October 02, 2019

Recorded as KEVIN JOHNSON, MSN, APRN, FNP-C

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) October 02, 2019

Nurse Practitioner (License #8262328-4405 in UT)

🟢
Initial NPI Registration & Enumeration October 02, 2019

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1770124687
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: October 02, 2019
Last Update: November 27, 2023
Deactivation Date: December 11, 2019
Sole Proprietor: No

Mailing Address

1055 N 500 W, Attn: Credentialing

Provo, UT 846043305

Phone: 8013548225

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.