Provider Demographics
NPI:1649601253
Name:JOHNSON, STEPHEN (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 OWENS ST # 3004
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94158-2334
Mailing Address - Country:US
Mailing Address - Phone:415-514-6243
Mailing Address - Fax:415-353-2225
Practice Address - Street 1:1500 OWENS ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94158-2334
Practice Address - Country:US
Practice Address - Phone:415-514-6243
Practice Address - Fax:415-353-2225
Is Sole Proprietor?:No
Enumeration Date:2013-12-06
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18275363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6012911OtherBLUE CROSS-BLUE SHIELD
TNP01328475OtherRR MEDICARE
TNQ006644Medicaid
TNQ006644Medicaid