Provider Demographics
NPI:1245877224
Name:JOHNSON, WINDELL LAMONT SR (FNP)
Entity type:Individual
Prefix:MR
First Name:WINDELL
Middle Name:LAMONT
Last Name:JOHNSON
Suffix:SR
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7604 TOLTEC DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-4586
Mailing Address - Country:US
Mailing Address - Phone:501-618-5317
Mailing Address - Fax:
Practice Address - Street 1:1401 S STATE ST STE C
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71601-5827
Practice Address - Country:US
Practice Address - Phone:870-534-5523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-09
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR124247363L00000X, 363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care