Provider Demographics
NPI:1346447190
Name:JOHNSON, LEIF BRYNOLF (PMHNP)
Entity Type:Individual
Prefix:MR
First Name:LEIF
Middle Name:BRYNOLF
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:MR
Other - First Name:LEIF
Other - Middle Name:BRYNOLF
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PMHNP
Mailing Address - Street 1:158 ZILLICOA ST
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-1079
Mailing Address - Country:US
Mailing Address - Phone:828-254-9494
Mailing Address - Fax:828-298-4870
Practice Address - Street 1:50 REDDICK RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-2717
Practice Address - Country:US
Practice Address - Phone:828-298-0186
Practice Address - Fax:828-298-4870
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC213163163WP0808X
NC5002627363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health