Provider Demographics
NPI:1740797133
Name:JOHNSON, MELISSA ANN (PMHNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 N WATER ST APT 524
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3661
Mailing Address - Country:US
Mailing Address - Phone:469-597-3335
Mailing Address - Fax:888-483-0118
Practice Address - Street 1:2717 N GRANDVIEW BLVD STE 102
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1672
Practice Address - Country:US
Practice Address - Phone:877-906-9699
Practice Address - Fax:888-483-0118
Is Sole Proprietor?:No
Enumeration Date:2018-01-07
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN204104163WP0808X
TN23867363LP0808X
TXAP140019363LP0808X
WI16318-33363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health