Provider Demographics
NPI:1609569714
Name:JOHNSON, JACQUELYN STELLA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:STELLA
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 1:1701 ROYAL LN APT 8205
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75229-3181
Mailing Address - Country:US
Mailing Address - Phone:214-886-0137
Mailing Address - Fax:
Practice Address - Street 1:11350 US HIGHWAY 380 STE 100
Practice Address - Street 2:
Practice Address - City:CROSSROADS
Practice Address - State:TX
Practice Address - Zip Code:76227-8319
Practice Address - Country:US
Practice Address - Phone:940-228-0721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-02
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX948039163WE0003X
TXF06230198363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency