Provider Demographics
NPI:1659019313
Name:JOHNSON, LUISITA JUNIO (NP)
Entity type:Individual
Prefix:
First Name:LUISITA
Middle Name:JUNIO
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8907 DUSTY RUN LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-6311
Mailing Address - Country:US
Mailing Address - Phone:210-954-1271
Mailing Address - Fax:
Practice Address - Street 1:11212 HIGHWAY 151 STE 360
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4504
Practice Address - Country:US
Practice Address - Phone:210-520-4100
Practice Address - Fax:210-520-4145
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1076052363LA2100X, 363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology