MEDICARE: NANCY ANN JOHNSON PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY01846	MO
2	103TC0700X	Clinical Psychologist	531	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	332725	OTHER	MO	HEALTHLINK
2	6151573	OTHER	MO	UNITED HEALTHCARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	110056	OTHER	MO	BLUE SHIELD/BLUE CHOICE

General Provider Information

NPI Number	:	1043268758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY ANN JOHNSON PHD

Provider Business Mailing Address
First Line	:	4400 W. 69TH ST.
Second Line	:	STE. 1500
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-8171
Country	:	US
Telephone Number	:	605-322-5700
Fax Number	:	605-322-5704

Provider Business Practice Location Address
First Line	:	4400 W. 69TH ST.
Second Line	:	STE. 1500
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-8171
Country	:	US
Telephone Number	:	605-322-5700
Fax Number	:	605-322-5704

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	07/23/2015

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Directions to “ NANCY ANN JOHNSON PHD” Practice Location

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