Doctor Name: | LEE ANN JOHNSON |
NPI Number: | 1144553991 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APN |
License Number: | A03262ANP |
Business Practice Address: | 201 N Spring St Fordyce, AR - 717423315 |
Business Phone Number: | 8703527197 |
Business Fax Number: | 8703527198 |
Mailing Address: | 201 N Spring St, FORDYCE |
State: | AR |
Postal Code: | 717423315 |
Phone Number: | 8703527197 |
Fax Number: | 8703527198 |
NPI Enumeration Date: | 09/11/2009 |
NPI Last Update Date: | 09/11/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | A03262ANP |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AR |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |