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Tiy Johnson

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

40 Autumn Fern Trl, Lillington, NC 27546-5155

PECOS Enrollment

Based on the most recent information from CMS, provider Tiy Johnson is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1598146177
Provider Type
Individual
Full Name
Johnson, Tiy
Credential
PA-C

Gender
Female
Sole Proprietor
No
Enumeration Date
6/9/2015
Last Updated
3/21/2024

Contact Information

Practice Location

40 Autumn Fern Trl, Lillington, NC 27546-5155

(910) 364-0971

Unlisted Fax

Mailing Location

5600 NE Holiday Dr, Lees Summit, MO 64064-2495

(816) 614-0549

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 0010-14083 North Carolina
Code 225200000X	Description Physical Therapy Assistant Respiratory, Developmental, Rehabilitative and Restorative Service Providers	License 5119 North Carolina

Tiy Johnson

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Mcneill, Kaitlin Briana

Eaton, Karley

Speight, Jamie L

Young, Rebecca Klein

Adeyemi, Norah

Johnson, Mackinsey Diane

Farawi, Dania Mahmoud

Mahood, Larry Blaine

Kivuti, Valerie Wawira

Jonas, Hannah Christine