Provider Demographics
NPI:1225006943
Name:JOHNSON, SALLY PATRICIA (RNC/WHNP)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:PATRICIA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RNC/WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11909 ALOE VERA TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1386
Mailing Address - Country:US
Mailing Address - Phone:512-258-7539
Mailing Address - Fax:
Practice Address - Street 1:100F W DEAN KEATON ST
Practice Address - Street 2:UNIVERSITY HEALTH SERVICES
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712-1006
Practice Address - Country:US
Practice Address - Phone:512-475-8216
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX433504363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health