Provider Demographics
NPI:1881105559
Name:SWOFFORD, JOHNATHAN JOEL (FNP-C)
Entity type:Individual
Prefix:
First Name:JOHNATHAN
Middle Name:JOEL
Last Name:SWOFFORD
Suffix:
Gender:M
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:PO BOX 1597
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:TX
Mailing Address - Zip Code:76426-1597
Mailing Address - Country:US
Mailing Address - Phone:940-233-6929
Mailing Address - Fax:877-892-4569
Practice Address - Street 1:1821 S FM 51
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3715
Practice Address - Country:US
Practice Address - Phone:855-277-2979
Practice Address - Fax:940-745-2020
Is Sole Proprietor?:No
Enumeration Date:2017-10-20
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135554363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX378573501Medicaid
TX8HT601OtherBCBSTX