Provider Demographics
NPI:1881070902
Name:JOHNSON, HOLLY (WHNP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9164 HEY JUDE LN E
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-9843
Mailing Address - Country:US
Mailing Address - Phone:806-676-0541
Mailing Address - Fax:806-372-5237
Practice Address - Street 1:951 MARINERS ISLAND BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94404-1560
Practice Address - Country:US
Practice Address - Phone:772-217-4557
Practice Address - Fax:888-352-7383
Is Sole Proprietor?:No
Enumeration Date:2015-07-31
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128668363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health