Provider Demographics
NPI:1639416340
Name:JOHNSON, JOEL ALLEN (NP-BC)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:ALLEN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:NP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 NE HWY 20 SUITE 610
Mailing Address - Street 2:FMB 100
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701
Mailing Address - Country:US
Mailing Address - Phone:305-304-9201
Mailing Address - Fax:
Practice Address - Street 1:23861 DODDS RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-9684
Practice Address - Country:US
Practice Address - Phone:541-213-3473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201906220NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily