TABITHA JOHANAN — NPI 1063904043 (Licensed & Credentialed Licensed Vocational Nurse in JARRELL, TX)

CMS-1500 Box 24J / 33a • NPI

1063904043

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

164X00000X

Licensed & Credentialed Licensed Vocational Nurse

Box 32 Service Location & ZIP+4

300 JUDGE KING DR, JARRELL, TX, 76537-1756

✓ 9-Digit EDI 837 ZIP+4 (76537-1756)

Practice Phone & Referral Fax

(512) 630-7652

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1063904043 (TABITHA JOHANAN) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1063904043` (NPI-1 Individual Practitioner)
Provider / Legal Name	TABITHA JOHANAN
Plain-English Specialty	Licensed & Credentialed Licensed Vocational Nurse NUCC Code: `164X00000X` (Licensed Vocational Nurse)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	300 JUDGE KING DR, JARRELL, TX, 76537-1756
Practice Telephone / Fax	Tel: (512) 630-7652
Administrative Mailing Address	300 JUDGE KING DR, JARRELL, TX, 76537-1756
Enumeration & Last Sync	Enumerated: 2018-06-05 \| CMS Record Updated: 2018-06-05

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

300 JUDGE KING DR, JARRELL, TX, 76537-1756

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Plain-English Taxonomy & CMS Crosswalk (164X00000X)

What Does Taxonomy Code 164X00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 164X00000X translates to:
"Licensed & Credentialed Licensed Vocational Nurse"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Licensed Vocational Nurse for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (TABITHA JOHANAN)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`164X00000X` — Licensed Vocational Nurse Plain English: Licensed & Credentialed Licensed Vocational Nurse	State: TX \| License: `223317` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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TABITHA JOHANAN (NPI #1063904043)