Provider Demographics
NPI:1457906448
Name:JOHNSON, VICTORIA M (NP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:M
Other - Last Name:PHELPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1510
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-1510
Mailing Address - Country:US
Mailing Address - Phone:812-615-5019
Mailing Address - Fax:812-615-5041
Practice Address - Street 1:3711 CASEY RD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8343
Practice Address - Country:US
Practice Address - Phone:812-490-1122
Practice Address - Fax:812-490-1123
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014197363L00000X
IN71009211A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner