Provider Demographics
NPI:1588840052
Name:JOHNSON, PAMELA F (FNP)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:F
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 1:104 E 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:CHADBOURN
Mailing Address - State:NC
Mailing Address - Zip Code:28431-1402
Mailing Address - Country:US
Mailing Address - Phone:910-654-3143
Mailing Address - Fax:910-654-4144
Practice Address - Street 1:104 E 7TH AVE
Practice Address - Street 2:
Practice Address - City:CHADBOURN
Practice Address - State:NC
Practice Address - Zip Code:28431-1402
Practice Address - Country:US
Practice Address - Phone:910-654-3143
Practice Address - Fax:910-654-4144
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002583A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200892480Medicaid
INM400068511Medicare PIN