Provider Demographics
NPI:1194009514
Name:JOHNSON, WHITNEY BROOKS (FNP-BC)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:BROOKS
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003A PIONEER STREET
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-6249
Mailing Address - Country:US
Mailing Address - Phone:912-284-1210
Mailing Address - Fax:912-284-9091
Practice Address - Street 1:2003A PIONEER STREET
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-6249
Practice Address - Country:US
Practice Address - Phone:912-284-1210
Practice Address - Fax:912-284-9091
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN195771363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily