Provider Demographics
NPI:1093786675
Name:JOHNSON, BETTY LYNNE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:LYNNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:231 WINDING OAK WAY
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-4089
Mailing Address - Country:US
Mailing Address - Phone:919-934-4365
Mailing Address - Fax:
Practice Address - Street 1:MAIN STREET
Practice Address - Street 2:CAMPBELL UNIVERSITY
Practice Address - City:BUIES CREEK
Practice Address - State:NC
Practice Address - Zip Code:27506
Practice Address - Country:US
Practice Address - Phone:910-893-1779
Practice Address - Fax:910-814-5567
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110840360363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical