Provider Demographics
NPI:1003351024
Name:JOHNSON, CARIE LYNN (APRN, NP-C)
Entity Type:Individual
Prefix:
First Name:CARIE
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12340 STATE ROUTE 104
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:OH
Mailing Address - Zip Code:45690-8968
Mailing Address - Country:US
Mailing Address - Phone:740-941-5180
Mailing Address - Fax:740-941-5178
Practice Address - Street 1:12340 STATE ROUTE 104
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-8968
Practice Address - Country:US
Practice Address - Phone:740-941-5180
Practice Address - Fax:740-941-5178
Is Sole Proprietor?:No
Enumeration Date:2016-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.020386363LF0000X
OHRN.360187163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse