Provider Demographics
NPI:1669804696
Name:JOHNSON, JOYCE M (MN, RN, CFNP)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MN, RN, CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3794 HIGHWAY 468 W
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-9008
Mailing Address - Country:US
Mailing Address - Phone:601-932-2880
Mailing Address - Fax:601-932-3984
Practice Address - Street 1:3794 HIGHWAY 468 W
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-9008
Practice Address - Country:US
Practice Address - Phone:601-932-2880
Practice Address - Fax:601-932-3984
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSF0512010363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily