Provider Demographics
NPI:1841242070
Name:JOHNSON, LINDSEY C (NP)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:C
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:C
Other - Last Name:STOCKTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27 GAMECOCK AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-3398
Mailing Address - Country:US
Mailing Address - Phone:843-769-8215
Mailing Address - Fax:843-769-8216
Practice Address - Street 1:27 GAMECOCK AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-3398
Practice Address - Country:US
Practice Address - Phone:843-769-8215
Practice Address - Fax:843-769-8216
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2744363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0946Medicaid
SCAA1089Medicare UPIN
SCNP0946Medicaid