1912951005 NPI number — MRS. ANGELA JOHNSON FNP

Table of content: MRS. ANGELA JOHNSON FNP (NPI 1912951005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912951005 NPI number — MRS. ANGELA JOHNSON FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
ANGELA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912951005
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 37087
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21297-3087
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-687-5616
Provider Business Mailing Address Fax Number:
828-650-8076

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
438 E VANN RD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
GREENEVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37743-7202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-278-1712
Provider Business Practice Location Address Fax Number:
423-278-1703
Provider Enumeration Date:
05/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WW0000X , with the licence number:  RD100377 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: APN6998 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: TN0100 . This is a "JOHN DEERE PROVIDER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 33485101 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7004058 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4062794 . This is a "BLUE CROSS PROVIDER" identifier . This identifiers is of the category "OTHER".




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