Provider Demographics
NPI:1801402631
Name:JOHNSON, DANIEL PATRICK (APRN)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:PATRICK
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 SINKING SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:TN
Mailing Address - Zip Code:37809-5003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2428 KNOB CREEK RD STE 102
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2396
Practice Address - Country:US
Practice Address - Phone:423-794-1074
Practice Address - Fax:423-794-1079
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAP0000028116363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily