Provider Demographics
NPI:1801519087
Name:JOHNSON, MICHELLE LAURANE (NP-C)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LAURANE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 BRYANT IRVIN RD STE 301
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4027
Mailing Address - Country:US
Mailing Address - Phone:214-557-0530
Mailing Address - Fax:
Practice Address - Street 1:5701 BRYANT IRVIN RD STE 301
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4027
Practice Address - Country:US
Practice Address - Phone:817-912-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1070688363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily