Provider Demographics
NPI:1831604834
Name:JOHNSON, ROBIN LOUISE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:LOUISE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 PRIVATE ROAD 8422
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75803-2799
Mailing Address - Country:US
Mailing Address - Phone:903-723-5593
Mailing Address - Fax:
Practice Address - Street 1:200 SPUR 113
Practice Address - Street 2:
Practice Address - City:TEAGUE
Practice Address - State:TX
Practice Address - Zip Code:75860-5174
Practice Address - Country:US
Practice Address - Phone:254-739-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX247718163W00000X
TXAP134959363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX24037OtherPRESCIPTIVE AUTHORIZATION
TX247718OtherREGISTERED NURSE
TXAP134959OtherNURSE PRACTITIONER