Provider Demographics
NPI:1851015267
Name:JOHNSON, NATASHA MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:MARIE
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1016 LESLIE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-5959
Mailing Address - Country:US
Mailing Address - Phone:910-876-7793
Mailing Address - Fax:
Practice Address - Street 1:1328 W BROAD ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NC
Practice Address - Zip Code:28337-9538
Practice Address - Country:US
Practice Address - Phone:910-777-5505
Practice Address - Fax:910-777-5537
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5017726363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily