Provider Demographics
NPI:1396052932
Name:JOHNSON, REBECCA N (CNMW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:N
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CNMW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-3309
Mailing Address - Country:US
Mailing Address - Phone:731-587-5321
Mailing Address - Fax:731-588-5999
Practice Address - Street 1:143 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237
Practice Address - Country:US
Practice Address - Phone:731-587-5321
Practice Address - Fax:731-588-5999
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000106208367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife