Provider Demographics
NPI:1770505141
Name:JOHNSON, OLIVIA DARNELL (APRN, FNP)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:DARNELL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:GRACE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, FNP
Mailing Address - Street 1:PO BOX 2106
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39302-2106
Mailing Address - Country:US
Mailing Address - Phone:601-703-3018
Mailing Address - Fax:
Practice Address - Street 1:1710 14TH ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4140
Practice Address - Country:US
Practice Address - Phone:601-703-1485
Practice Address - Fax:601-703-1488
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR861714363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily