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

Nicholas Samuel Johnson, FNP

Individual provider Family Medicine Physician · NPI 1164309985

Nicholas Samuel Johnson, FNP is a Nurse Practitioner in O Fallon, Missouri. Qualified in 2025, 1 year ago. Practices as a sole proprietor. Licensed in Missouri.

Years since qualifying
1
Licensed in
MO
In the registry since
2025
What do these letters mean?
FNP — Family Nurse Practitioner
A nurse practitioner who treats patients of all ages, much like a family doctor.

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Practice location Address checks out

2223 Technology Dr
O Fallon, MO 63368-7272
Phone: (636) 561-5999
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 2019006383 (MO)

Record details

NPI number1164309985
Entity typeIndividual (Type 1)
GenderMale
Credentials FNP
Sole proprietorYes
NPI enumeratedAugust 21, 2025
Last updated in NPPESAugust 21, 2025
Certification dateAugust 21, 2025
Mailing address2223 Technology Dr, O Fallon, MO 63368-7272

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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