Provider Demographics
NPI:1508824145
Name:JOHNSON, NICOLE D (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:D
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:D
Other - Last Name:HOLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:400 W ARBROOK BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-3175
Mailing Address - Country:US
Mailing Address - Phone:817-276-6850
Mailing Address - Fax:817-861-3023
Practice Address - Street 1:400 W ARBROOK BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-3175
Practice Address - Country:US
Practice Address - Phone:817-276-6850
Practice Address - Fax:817-861-3023
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8733207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
10078811OtherAMERICAID
TX168202302Medicaid
TX168202304Medicaid
TX19620OtherPARKLAND
TX0058NSOtherBLUE CROSS BLUE SHIELD
TX168202309Medicaid
TX159137OtherUNICARE
TX168202306Medicaid
TX168202303OtherTHSTEPS
TX9075998OtherCIGNA
TX168202305Medicaid
TXTXB122683Medicare PIN
TX9075998OtherCIGNA
TX168202303OtherTHSTEPS
TX612654Medicare PIN
TX168202305Medicaid
TX8L3151Medicare PIN