Provider Demographics
NPI:1407161995
Name:JOHNSON, VALERIE L (PA-C)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 22ND AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1844
Mailing Address - Country:US
Mailing Address - Phone:615-320-0007
Mailing Address - Fax:615-320-0009
Practice Address - Street 1:330 22ND AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1844
Practice Address - Country:US
Practice Address - Phone:615-320-0007
Practice Address - Fax:615-320-0009
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1855363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I973556Medicare PIN