Provider Demographics
NPI:1740539899
Name:JOHNSON, CHRISTINA M (PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-2857
Mailing Address - Country:US
Mailing Address - Phone:304-481-7480
Mailing Address - Fax:
Practice Address - Street 1:1818 WASHINGTON BLVD STE H
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-2080
Practice Address - Country:US
Practice Address - Phone:740-423-3618
Practice Address - Fax:740-568-4553
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV583363AM0700X
OH50.004341363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical