Provider Demographics
NPI:1447307624
Name:JOHNSON, SHERI L (MPAS, PA-C)
Entity type:Individual
Prefix:MS
First Name:SHERI
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 TIGER LILY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5587
Mailing Address - Country:US
Mailing Address - Phone:402-420-7000
Mailing Address - Fax:402-420-6969
Practice Address - Street 1:4101 TIGER LILY RD STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5587
Practice Address - Country:US
Practice Address - Phone:402-420-7000
Practice Address - Fax:402-420-6969
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1352363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE37524OtherBCBS NE
NE255227OtherMIDLANDS CHOICE
NE37524OtherBCBS NE
NE91186278513Medicaid
NE098706001Medicare PIN