Provider Demographics
NPI:1255615498
Name:JOHNSON, COURTNEY J (CNP)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2458 SEQUOIA COURT
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-7735
Mailing Address - Country:US
Mailing Address - Phone:740-503-2340
Mailing Address - Fax:
Practice Address - Street 1:55 CENTENNIAL BLVD
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-1187
Practice Address - Country:US
Practice Address - Phone:740-779-4134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA12606/RN264386COA363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily