Provider Demographics
NPI:1679576268
Name:JOHNSON, JUDITH L (CRNP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:L
Other - Last Name:BOSSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1108 ROSS CLARK CIR
Mailing Address - Street 2:HOSPITALIST OFFICE
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-3022
Mailing Address - Country:US
Mailing Address - Phone:334-712-3635
Mailing Address - Fax:334-699-4387
Practice Address - Street 1:1108 ROSS CLARK CIR
Practice Address - Street 2:HOSPITALIST OFFICE
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3022
Practice Address - Country:US
Practice Address - Phone:334-712-3635
Practice Address - Fax:334-699-4387
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2188812363L00000X
AL1-095402363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305523000Medicaid
FL305523000Medicaid