Provider Demographics
NPI:1386217685
Name:JOHNSON, ZACHARY T (NP)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:T
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 N SENATE BLVD STE 635
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1212
Mailing Address - Country:US
Mailing Address - Phone:317-962-3235
Mailing Address - Fax:317-962-3916
Practice Address - Street 1:1801 N SENATE BLVD STE 635
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1212
Practice Address - Country:US
Practice Address - Phone:317-962-3235
Practice Address - Fax:317-962-3916
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71011255A363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care