Provider Demographics
NPI:1588853956
Name:JOHNSON, DONNA K (RN, MSN, APRN, NP-C)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:K
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN, MSN, APRN, NP-C
Other - Prefix:MRS
Other - First Name:DONNA
Other - Middle Name:B
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, MSN, APRN, NP-C
Mailing Address - Street 1:35 RAY E TALLEY CT
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-6772
Mailing Address - Country:US
Mailing Address - Phone:864-967-7028
Mailing Address - Fax:
Practice Address - Street 1:35 RAY E TALLEY CT
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-6772
Practice Address - Country:US
Practice Address - Phone:864-967-7028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4359363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily