Provider Demographics
NPI:1578908091
Name:JOHNS, SANDY D (WHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:SANDY
Middle Name:D
Last Name:JOHNS
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:SANDY
Other - Middle Name:D
Other - Last Name:SILKWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHNP-BC
Mailing Address - Street 1:2340 KATY LN
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2300
Mailing Address - Country:US
Mailing Address - Phone:573-776-7393
Mailing Address - Fax:573-776-7396
Practice Address - Street 1:2210 BARRON RD STE 206
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-1908
Practice Address - Country:US
Practice Address - Phone:573-772-7000
Practice Address - Fax:573-686-1315
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013005510363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology