Provider Demographics
NPI:1417208091
Name:LAW JOHNSON, RYAN NICOLE (DNP, FNP)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:NICOLE
Last Name:LAW JOHNSON
Suffix:
Gender:F
Credentials:DNP, FNP
Other - Prefix:
Other - First Name:RYAN
Other - Middle Name:NICOLE
Other - Last Name:LAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1189 TIBWIN RD
Mailing Address - Street 2:
Mailing Address - City:MC CLELLANVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29458-9405
Mailing Address - Country:US
Mailing Address - Phone:843-887-3274
Mailing Address - Fax:843-887-3929
Practice Address - Street 1:1189 TIBWIN RD
Practice Address - Street 2:
Practice Address - City:MC CLELLANVILLE
Practice Address - State:SC
Practice Address - Zip Code:29458-9405
Practice Address - Country:US
Practice Address - Phone:843-887-3274
Practice Address - Fax:843-887-3929
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17944363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP01264537OtherRAIL ROAD MEDICARE
SCNP2143Medicaid
SCSC02055277Medicare PIN