Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Nicholas Roy Johnson, PA-C

Individual provider Physician Assistant · NPI 1902534910

Nicholas Roy Johnson, PA-C is a Physician Assistant in Maple Grove, Minnesota. Qualified in 2022, 4 years ago. Practices with Fairview Express Care, a 1,964-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in Minnesota.

Years since qualifying
4
Licensed in
MN
In the registry since
2022
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

14500 99th Ave N
Maple Grove, MN 55369-4730
Phone: (763) 898-1000
Fax: (763) 898-1009
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 11111 Anderson Lakes Pkwy, Eden Prairie, MN 55344-4145 — (952) 451-3906

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 14147 (MN)

Record details

NPI number1902534910
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedAugust 9, 2022
Last updated in NPPESOctober 13, 2022
Certification dateOctober 13, 2022

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Fairview Express Care — 1964 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations4 on file with Medicare

Other providers in Maple Grove