Provider Demographics
NPI:1013300383
Name:JOHNSON, JULIE RANDOLPH (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:RANDOLPH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 N MEBANE ST STE 123
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-3900
Mailing Address - Country:US
Mailing Address - Phone:336-639-7149
Mailing Address - Fax:336-639-7814
Practice Address - Street 1:236 N MEBANE ST STE 123
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-3900
Practice Address - Country:US
Practice Address - Phone:336-639-7149
Practice Address - Fax:336-639-7141
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-11
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007496261QP2300X, 363LG0600X, 363LC1500X, 363LF0000X, 363LW0102X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1013300383Medicaid
NC1194382945Medicaid