Provider Demographics
NPI:1003569898
Name:JOHNSON, ARCHELLE (AG-PNP)
Entity Type:Individual
Prefix:
First Name:ARCHELLE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:AG-PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3712 SUNORA DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23234-1438
Mailing Address - Country:US
Mailing Address - Phone:804-878-0942
Mailing Address - Fax:866-556-8809
Practice Address - Street 1:101 BUFORD RD STE B111
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-5292
Practice Address - Country:US
Practice Address - Phone:804-878-0942
Practice Address - Fax:888-556-8809
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024183604363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care