Provider Demographics
NPI:1407984669
Name:JOHNS, DIRK A (FNP)
Entity Type:Individual
Prefix:MR
First Name:DIRK
Middle Name:A
Last Name:JOHNS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-2318
Mailing Address - Country:US
Mailing Address - Phone:508-795-1555
Mailing Address - Fax:508-755-4464
Practice Address - Street 1:10 BROOKSIDE DR
Practice Address - Street 2:
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-2318
Practice Address - Country:US
Practice Address - Phone:413-531-7078
Practice Address - Fax:413-531-7078
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9434363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1600371Medicaid
MAY39849OtherBLUE CROSS BLUE SHIELD
MAU60940Medicare UPIN
MA1600371Medicaid
MAY39849OtherBLUE CROSS BLUE SHIELD