Provider Demographics
NPI: | 1710336771 |
---|---|
Name: | JOHNSON, CHRISTOPHER ANDREW (FNP, WHNP) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | CHRISTOPHER |
Middle Name: | ANDREW |
Last Name: | JOHNSON |
Suffix: | |
Gender: | M |
Credentials: | FNP, WHNP |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 2989 E AROW STREET |
Mailing Address - Street 2: | BLDG 1175 |
Mailing Address - City: | YUMA |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85365 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 928-269-2416 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2989 E AROW STREET |
Practice Address - Street 2: | BLDG 1175 |
Practice Address - City: | YUMA |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85365 |
Practice Address - Country: | US |
Practice Address - Phone: | 928-269-2416 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2016-06-09 |
Last Update Date: | 2023-08-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
VA | 0024176539 | 363LW0102X, 363LF0000X, 171000000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No | 363LW0102X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No | 171000000X | Other Service Providers | Military Health Care Provider |