Provider Demographics
NPI:1003413808
Name:JOHNSON, JOHN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 W LAMBERTH RD STE A
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-2662
Mailing Address - Country:US
Mailing Address - Phone:903-892-6700
Mailing Address - Fax:903-892-6774
Practice Address - Street 1:121 W LAMBERTH RD STE A
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-2662
Practice Address - Country:US
Practice Address - Phone:903-892-6700
Practice Address - Fax:903-892-6774
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1011652363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health