Provider Demographics
NPI:1205284916
Name:JOHNSON, STEPHANIE B (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:B
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:BROOKE
Other - Last Name:BOWDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:902 KIRKWOOD AVE NW
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-5121
Mailing Address - Country:US
Mailing Address - Phone:828-754-0101
Mailing Address - Fax:828-757-0402
Practice Address - Street 1:902 KIRKWOOD AVE NW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5121
Practice Address - Country:US
Practice Address - Phone:287-540-1018
Practice Address - Fax:828-757-0402
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011414363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner