Provider Demographics
NPI:1275014409
Name:JOHNSON, LINDSEY BLAIR (APRN)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:BLAIR
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 E MATTHEWS AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4336
Mailing Address - Country:US
Mailing Address - Phone:870-931-4442
Mailing Address - Fax:870-802-0206
Practice Address - Street 1:1107 E MATTHEWS AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4315
Practice Address - Country:US
Practice Address - Phone:870-931-4442
Practice Address - Fax:870-802-0206
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-26
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005816363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily