Provider Demographics
NPI:1396223970
Name:JOHNSON, WILLIAM GLEN (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:GLEN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10906 JANET LEE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-4222
Mailing Address - Country:US
Mailing Address - Phone:210-687-7875
Mailing Address - Fax:210-758-5623
Practice Address - Street 1:900 OBLATE DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-7332
Practice Address - Country:US
Practice Address - Phone:210-314-4055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-05
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138051363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily