Provider Demographics
NPI:1770864381
Name:JOHNSON, AMY CHAPMAN (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:CHAPMAN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:CBO, STE 4200
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-0434
Mailing Address - Country:US
Mailing Address - Phone:601-984-6426
Mailing Address - Fax:601-815-0434
Practice Address - Street 1:239 BOWLING GREEN RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MS
Practice Address - Zip Code:39095-5167
Practice Address - Country:US
Practice Address - Phone:662-834-5339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR869698363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS442663YPPXMedicare PIN