Provider Demographics
NPI:1427595206
Name:JOHNS, NATALIE K (MMS, PA-C)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:K
Last Name:JOHNS
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 S GEORGE DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-4172
Mailing Address - Country:US
Mailing Address - Phone:480-839-9097
Mailing Address - Fax:480-839-1762
Practice Address - Street 1:3200 S GEORGE DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-4172
Practice Address - Country:US
Practice Address - Phone:480-839-9097
Practice Address - Fax:480-839-1762
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6636363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical