Provider Demographics
NPI:1235906884
Name:JOHNSON, HUNTER CHEVELLE (APP)
Entity Type:Individual
Prefix:
First Name:HUNTER
Middle Name:CHEVELLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-2111
Mailing Address - Fax:
Practice Address - Street 1:100 PECAN CROSSING DR
Practice Address - Street 2:
Practice Address - City:HORSESHOE BAY
Practice Address - State:TX
Practice Address - Zip Code:78657-6097
Practice Address - Country:US
Practice Address - Phone:830-596-6800
Practice Address - Fax:830-596-6901
Is Sole Proprietor?:No
Enumeration Date:2023-12-05
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1149884363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily