Provider Demographics
NPI:1912951005
Name:JOHNSON, ANGELA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP
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 37087
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3087
Mailing Address - Country:US
Mailing Address - Phone:828-687-5616
Mailing Address - Fax:828-650-8076
Practice Address - Street 1:438 E VANN RD
Practice Address - Street 2:SUITE 202
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-7202
Practice Address - Country:US
Practice Address - Phone:423-278-1712
Practice Address - Fax:423-278-1703
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRD100377163WW0000X
TNAPN6998363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0100OtherJOHN DEERE PROVIDER
TN33485101Medicaid
NC7004058Medicaid
4062794OtherBLUE CROSS PROVIDER
NC7004058Medicaid
P58410Medicare UPIN