Provider Demographics
NPI:1477783942
Name:JOHNSON, COURTNEY ROBINSON (CNP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ROBINSON
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:JANSEN
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:4260 GLENDALE MILFORD RD
Mailing Address - Street 2:STE 202
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-3763
Mailing Address - Country:US
Mailing Address - Phone:513-563-6883
Mailing Address - Fax:513-563-1872
Practice Address - Street 1:4260 GLENDALE MILFORD RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-3763
Practice Address - Country:US
Practice Address - Phone:513-563-6883
Practice Address - Fax:513-563-1872
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.10785-NP363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2998172Medicaid
OHNP31542Medicare PIN