Provider Demographics
NPI:1245079268
Name:JOHNSON, DEVYN ALAISEA-ROOKH
Entity type:Individual
Prefix:
First Name:DEVYN
Middle Name:ALAISEA-ROOKH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N MEDICAL DRIVE UNC-CH-SON
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-0001
Mailing Address - Country:US
Mailing Address - Phone:919-966-4260
Mailing Address - Fax:
Practice Address - Street 1:101 E 2ND ST
Practice Address - Street 2:
Practice Address - City:KENLY
Practice Address - State:NC
Practice Address - Zip Code:27542-7794
Practice Address - Country:US
Practice Address - Phone:919-284-4025
Practice Address - Fax:919-284-5965
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC5022832363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program