Provider Demographics
NPI:1871239202
Name:JOHNSON, LAUREN (CNM, WHNP-BC, RN)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:
Credentials:CNM, WHNP-BC, RN
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:RADNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM, WHNP-BC, RN
Mailing Address - Street 1:310 NEW BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-4756
Mailing Address - Country:US
Mailing Address - Phone:910-621-4266
Mailing Address - Fax:
Practice Address - Street 1:310 NEW BRIDGE ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-4756
Practice Address - Country:US
Practice Address - Phone:910-621-4266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACNM07646367A00000X
NC363264367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife