Provider Demographics
NPI:1225144231
Name:JOHNSON, ADRENA ELAINE (PA-C)
Entity Type:Individual
Prefix:
First Name:ADRENA
Middle Name:ELAINE
Last Name:JOHNSON
Suffix:
Gender:F
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 1:47 PINE RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-9483
Mailing Address - Country:US
Mailing Address - Phone:336-294-0919
Mailing Address - Fax:
Practice Address - Street 1:551 BREVARD RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-2316
Practice Address - Country:US
Practice Address - Phone:828-212-7021
Practice Address - Fax:828-232-8218
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100672363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC100672OtherPA-C