Provider Demographics
NPI:1043299647
Name:JOHNSON, HERBERT ANTHONY JR (PA-C)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:ANTHONY
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 PINE WOOD WAY
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-7321
Mailing Address - Country:US
Mailing Address - Phone:360-257-2394
Mailing Address - Fax:360-257-2396
Practice Address - Street 1:BEHAVIORAL HEALTH CLINIC, SARP,
Practice Address - Street 2:NAVAL HOSPITAL
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98278-0001
Practice Address - Country:US
Practice Address - Phone:360-257-2394
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical