Provider Demographics
NPI:1205101110
Name:JOHNSON, KATHERINE WOOD (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:WOOD
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MISS
Other - First Name:KATHERINE
Other - Middle Name:LEE
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:4805 COLUMBIA PIKE
Mailing Address - Street 2:
Mailing Address - City:THOMPSONS STATION
Mailing Address - State:TN
Mailing Address - Zip Code:37179-5207
Mailing Address - Country:US
Mailing Address - Phone:615-791-0974
Mailing Address - Fax:615-791-9825
Practice Address - Street 1:4805 COLUMBIA PIKE
Practice Address - Street 2:
Practice Address - City:THOMPSONS STATION
Practice Address - State:TN
Practice Address - Zip Code:37179-5207
Practice Address - Country:US
Practice Address - Phone:615-791-0974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-12
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16235363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily