Provider Demographics
NPI:1255004313
Name:JOHNSON, JANNA MARIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:JANNA
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47111-9535
Mailing Address - Country:US
Mailing Address - Phone:812-288-2488
Mailing Address - Fax:812-288-6603
Practice Address - Street 1:2100 MARKET ST
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:IN
Practice Address - Zip Code:47111-9535
Practice Address - Country:US
Practice Address - Phone:812-503-5100
Practice Address - Fax:812-288-6603
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71011239A207QA0401X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300053678Medicaid
ININ3604044OtherMEDICARE IN