Provider Demographics
NPI:1497961494
Name:IRELAND, JOHNNIE MAE (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:JOHNNIE
Middle Name:MAE
Last Name:IRELAND
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:JOHNNIE
Other - Middle Name:IRELAND
Other - Last Name:SLAUGHTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHNP-BC
Mailing Address - Street 1:948 E MULKEY ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-6547
Mailing Address - Country:US
Mailing Address - Phone:817-422-8358
Mailing Address - Fax:817-257-7279
Practice Address - Street 1:1919 8TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-1358
Practice Address - Country:US
Practice Address - Phone:817-332-7722
Practice Address - Fax:817-900-8675
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX547683363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health