Provider Demographics
NPI:1780966127
Name:JOHNSON, WHITNEY (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:597 N STATE HIGHWAY 181
Mailing Address - Street 2:
Mailing Address - City:GOSNELL
Mailing Address - State:AR
Mailing Address - Zip Code:72315-5905
Mailing Address - Country:US
Mailing Address - Phone:870-532-7879
Mailing Address - Fax:
Practice Address - Street 1:597 N STATE HIGHWAY 181
Practice Address - Street 2:
Practice Address - City:GOSNELL
Practice Address - State:AR
Practice Address - Zip Code:72315-5905
Practice Address - Country:US
Practice Address - Phone:501-642-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019039813363LP0808X
ARR085765163WP0808X
AR216739363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health