Individual provider · Type 1 NPI

Shannon Johnston

Nurse Practitioner · Indianapolis, IN

NPI number 1902212608 Active

Practice location

675 Justice Way Rm C0049
Indianapolis, IN 46203-1574

Call (877) 465-6650 Map

Fax (804) 294-2775

Mailing address

12034 Villa Dorado Dr
St. Louis, MO 63146-4747

Other practice locations

  • 14477 Callaway Ct, Chesterfield, MO 63017-2303 · (314) 692-0703

Specialties and licenses

TaxonomyCodeLicense
Nurse Practitioner 363L00000X2014021871 (MO)
Nurse Practitioner 363L00000X209.012733 (IL)
Family Nurse Practitioner 363LF0000X209.012733 (IL)
Family Nurse Practitioner 363LF0000X2014021871 (MO)
Nurse Practitioner Primary 363L00000X71015147A (IN)

Nurse Practitioner: (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 wit…

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About NPI 1902212608

Shannon Johnston's National Provider Identifier is 1902212608, issued on Jul 2, 2014. The primary taxonomy on file is Nurse Practitioner (363L00000X), and the practice location is in Indianapolis, IN. The record was last updated on Jul 31, 2025.