Provider Demographics
NPI:1518506849
Name:JOHNSON, ASHLEY (FNP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 BENNEDICT LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-1920
Mailing Address - Country:US
Mailing Address - Phone:707-837-6641
Mailing Address - Fax:
Practice Address - Street 1:200 SYDNEY
Practice Address - Street 2:
Practice Address - City:THORNDALE
Practice Address - State:TX
Practice Address - Zip Code:76577-5432
Practice Address - Country:US
Practice Address - Phone:707-837-6641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32916363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily