TIESHA D JOHNSON PMHNP
NPI 1104082346
Nurse Practitioner - Psychiatric/Mental Health in Utica, NY

Q: What is Tiesha Johnson's NPI number?

The NPI number for Tiesha Johnson is 1104082346. It was assigned to this individual provider in the NPPES registry on August 6, 2008.

Q: What is Tiesha Johnson's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Q: When was this NPI record last updated?

The NPPES record for Tiesha Johnson was last updated on December 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since August 06, 2008PECOS EnrolledAccepts Medicare Assignment

1676 SUNSET AVE, UTICA, NY 13502(315) 624-4801(315) 624-5401 Get Directions Write a Review

NPPES record last updated: December 11, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Dec 11, 2025, Apr 11, 2025, Apr 9, 2024 and 4 more (7 updates tracked since 2018).

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About Tiesha D Johnson Pmhnp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TIESHA D JOHNSON PMHNP (NPI 1104082346) is an individual psychiatric/mental health provider in Utica, New York, licensed in New York (401131) and active in the NPI registry since August 2008. She is enrolled in Medicare PECOS, is affiliated with Wynn Hospital, and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1104082346

Entity TypeIndividualFemale

Primary Taxonomy363LP0808X

Provider Legal NameTIESHA D JOHNSONCredential: PMHNP

Location Address1676 SUNSET AVEUtica, NY 13502-5416

Mailing Address111 Hospital Dr, Attn: Credentialing DeptUtica, NY 13502 · (315) 801-8534 · Fax (315) 801-8391

Phone(315) 624-4801

Fax(315) 624-5401

Sole ProprietorNo

Medical School CMSOtherGraduated 2018

Enumeration DateAugust 6, 2008

Last NPPES UpdateDecember 11, 20257 updates tracked since enumeration

NPPES CertifiedDecember 11, 2025

✔ NPI 1104082346 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP0808X

Licenses✔ Licensed in NY · 401131✔ Licensed in OH · APRN.CNP.024042

1676 SUNSET AVE, Utica, NY 13502

Open in Google Maps ↗

Secondary Practice Locations 2

Location 1700 Childrens DrColumbus, OH 43205-2639 · Phone (614) 722-4545 · Fax (614) 722-4575

Location 2444 Butterfly Gardens DrColumbus, OH 43215-3427 · Phone (614) 938-0167 · Fax (614) 938-0170

Other Identifiers 1

Medicaid0384373OH

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include CareSource, Oscar Health Insurance, Oscar Insurance Corporation of Ohio and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Tiesha D Johnson Pmhnp is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4385770478

PECOS Enrollment IDI20251219003256

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Wynn Hospital

Acute Care Hospitals · Utica, NY

2/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number330044

Location111 Hospital DriveUtica, NY 13502 · Oneida County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 13502 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$84.93 typical visit price

range $54.87 – $166.88

Typical copayment $21.23 (range $13.71 – $41.72)

Most-billed visit code 99203

Established Patient

$97.08 typical visit price

range $17.54 – $136.14

Typical copayment $24.27 (range $4.38 – $34.03)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ROSAYSELA CABRERA MSW

Social Worker