Provider Demographics
NPI:1558750950
Name:JOHNSON, DEBORAH SMITH (FNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:SMITH
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 1:3346 WESTGATE DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-7960
Mailing Address - Country:US
Mailing Address - Phone:828-432-6384
Mailing Address - Fax:
Practice Address - Street 1:927 EAST BLVD.
Practice Address - Street 2:SOUTHEAST ANESTHESIOLOGY CONSULTANTS
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203
Practice Address - Country:US
Practice Address - Phone:704-377-5772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007417363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily