Provider Demographics
NPI:1336689900
Name:JOHNSON, LEIGH ELIZABETH (PNP)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:ELIZABETH
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PNP
Other - Prefix:
Other - First Name:LEIGH
Other - Middle Name:
Other - Last Name:CARBUTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PNP
Mailing Address - Street 1:100 KIMEL FOREST DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6074
Mailing Address - Country:US
Mailing Address - Phone:336-716-1331
Mailing Address - Fax:
Practice Address - Street 1:4515 PREMIER DR STE 203
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8356
Practice Address - Country:US
Practice Address - Phone:336-802-2200
Practice Address - Fax:336-802-2201
Is Sole Proprietor?:No
Enumeration Date:2017-03-02
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009290363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics