Provider Demographics
NPI:1679710768
Name:JOHNSON, ABIGAIL DIANE (CNM, APRN)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:DIANE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CNM, APRN
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:DIANE
Other - Last Name:SKINNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM, WHNP-BC, MSN
Mailing Address - Street 1:720 S. 3RD ST.
Mailing Address - Street 2:
Mailing Address - City:ROGES
Mailing Address - State:AR
Mailing Address - Zip Code:72756
Mailing Address - Country:US
Mailing Address - Phone:479-640-0451
Mailing Address - Fax:
Practice Address - Street 1:OB HOSPITALIST GROUP
Practice Address - Street 2:777 LOWNDES HILL RD. BLDG. 1
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607
Practice Address - Country:US
Practice Address - Phone:864-908-3530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-12
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03189363LW0102X
ARM02112 CNM367A00000X
OK98063367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health