Provider Demographics
NPI:1609164193
Name:JOHNSON, AMANDA MCGUIRE (ANP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MCGUIRE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 BANKS TOWN RD
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-9296
Mailing Address - Country:US
Mailing Address - Phone:828-777-3003
Mailing Address - Fax:855-494-0022
Practice Address - Street 1:700 SHEPHERD ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-6472
Practice Address - Country:US
Practice Address - Phone:828-559-1591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9318870363L00000X
NC5005536363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7006288Medicaid
NCNC5540BMedicare PIN
NCNC5440CMedicare PIN
NC7006288Medicaid
NCNC5540DMedicare PIN