Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Illisia Marie Johnston, NP-C

Individual provider Family Nurse Practitioner · NPI 1003486556

Illisia Marie Johnston, NP-C is a Nurse Practitioner in Laurel, Mississippi. Qualified in 2021, 5 years ago. Practices with South Central Clinics, Inc, a 122-clinician group and accepts Medicare assignment. Licensed in Mississippi.

Years since qualifying
5
Licensed in
MS
In the registry since
2021
What do these letters mean?
NP-C — Nurse Practitioner, Certified
A nurse practitioner certified by the AANP.

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Practice location Address checks out

1008 N 15th Ave
Laurel, MS 39440-2656
Phone: (601) 426-5125
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence F06212134 (MS)

Record details

NPI number1003486556
Entity typeIndividual (Type 1)
GenderFemale
Credentials NP-C
Sole proprietorYes
NPI enumeratedJune 28, 2021
Last updated in NPPESOctober 3, 2024
Certification dateOctober 3, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice South Central Clinics, Inc — 122 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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