Provider Demographics
NPI:1760688733
Name:JOHNSON, NATALIE RENEE (PA C)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:RENEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4360 MONTEBELLO DR STE 900
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-7210
Mailing Address - Country:US
Mailing Address - Phone:719-388-1594
Mailing Address - Fax:719-388-1595
Practice Address - Street 1:4360 MONTEBELLO DR STE 900
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-7210
Practice Address - Country:US
Practice Address - Phone:719-388-1594
Practice Address - Fax:719-388-1595
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04361363A00000X
COPA.0004285363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical