Provider Demographics
NPI:1598357345
Name:JOHNSON, LINDSAY RENEE (PA)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:RENEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4246 BENEDICT WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-2692
Mailing Address - Country:US
Mailing Address - Phone:585-755-3787
Mailing Address - Fax:
Practice Address - Street 1:140 W MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45502-1369
Practice Address - Country:US
Practice Address - Phone:937-398-1066
Practice Address - Fax:937-521-1406
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant