Provider Demographics
NPI:1831630110
Name:JOHNSON, CHRISTEN HOPE
Entity type:Individual
Prefix:
First Name:CHRISTEN
Middle Name:HOPE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11001 EXECUTIVE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4393
Mailing Address - Country:US
Mailing Address - Phone:501-975-7676
Mailing Address - Fax:501-975-0653
Practice Address - Street 1:3343 SPRINGHILL DR STE 1035
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2930
Practice Address - Country:US
Practice Address - Phone:501-975-7676
Practice Address - Fax:501-975-0653
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA322538207R00000X
ARE-16570207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2440578Medicaid