Provider Demographics
NPI:1679248934
Name:JOHNSON, JENNIFER AMANDA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:AMANDA
Last Name:JOHNSON
Suffix:
Gender:F
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 1:1509 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-1652
Mailing Address - Country:US
Mailing Address - Phone:254-434-8448
Mailing Address - Fax:
Practice Address - Street 1:1509 OAKWOOD DR
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-1652
Practice Address - Country:US
Practice Address - Phone:254-434-8448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1049262363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily