Provider Demographics
NPI:1770210767
Name:JOHNSON, MELISSA LOWDER (APRN DNP PMHNP)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:LOWDER
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN DNP PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 E OLIVE BERRY LN
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-6846
Mailing Address - Country:US
Mailing Address - Phone:801-556-0695
Mailing Address - Fax:
Practice Address - Street 1:167 E OLIVE BERRY LN
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-6846
Practice Address - Country:US
Practice Address - Phone:801-556-0695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3083210-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT3083210-3102OtherUTAH DOPL
UT3083210-4405OtherUTAH DOPL (APRN)
UT3083210-8900OtherUTAH DOPL (APRN CONTROLLED SUBSTANCE)
2022012145OtherAMERICAN NURSES CREDENTIALING CENTER