Provider Demographics
NPI:1508516204
Name:JOHNSON, SARAH BAGLEY (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:BAGLEY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4940 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-2735
Mailing Address - Country:US
Mailing Address - Phone:410-550-0074
Mailing Address - Fax:
Practice Address - Street 1:216 E PULASKI HWY STE 212
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6589
Practice Address - Country:US
Practice Address - Phone:302-384-7843
Practice Address - Fax:302-351-6427
Is Sole Proprietor?:No
Enumeration Date:2022-03-25
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR183172363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health