| Doctor Name: | LISA LYNN JOHNSON |
| NPI Number: | 1043652217 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN |
| License Number: | TMP 147286 |
| Business Practice Address: | 2600 Ottawa Rd Neodesha, KS - 667571897 |
| Business Phone Number: | 6203252611 |
| Business Fax Number: | 6203258460 |
| Mailing Address: | 2600 Ottawa Rd, P.o. Box 360 NEODESHA |
| State: | KS |
| Postal Code: | 667571897 |
| Phone Number: | 6203252611 |
| Fax Number: | 6203258460 |
| NPI Enumeration Date: | 07/29/2013 |
| NPI Last Update Date: | 08/22/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | TMP 147286 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |