Provider Demographics
NPI:1043652217
Name:JOHNSON, LISA LYNN (APRN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 OTTAWA RD
Mailing Address - Street 2:P.O. BOX 360
Mailing Address - City:NEODESHA
Mailing Address - State:KS
Mailing Address - Zip Code:66757-1897
Mailing Address - Country:US
Mailing Address - Phone:620-325-2611
Mailing Address - Fax:620-325-8460
Practice Address - Street 1:2600 OTTAWA RD
Practice Address - Street 2:
Practice Address - City:NEODESHA
Practice Address - State:KS
Practice Address - Zip Code:66757-1897
Practice Address - Country:US
Practice Address - Phone:620-325-2611
Practice Address - Fax:620-325-8460
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSTMP 147286363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily