Provider Demographics
NPI:1811967409
Name:JOHNSON, REBECCA K (APN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:K
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 W 7TH ST
Mailing Address - Street 2:HOME HEALTH CARE SERVICE 11HC/LR
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5446
Mailing Address - Country:US
Mailing Address - Phone:501-257-5080
Mailing Address - Fax:501-224-0851
Practice Address - Street 1:4300 W 7TH ST
Practice Address - Street 2:HOME HEALTH CARE SERVICE 11HC/LR
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5446
Practice Address - Country:US
Practice Address - Phone:501-257-5080
Practice Address - Fax:501-224-0851
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01856363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y382Medicare ID - Type Unspecified