Doctor Name: | CHRISTOPHER JOHNSON |
NPI Number: | 1578945770 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | FNP-BC |
License Number: | A004425 |
Business Practice Address: | 130 J F Blvd Lonoke, AR - 720869365 |
Business Phone Number: | 5016760858 |
Business Fax Number: | |
Mailing Address: | 130 J F Blvd, LONOKE |
State: | AR |
Postal Code: | 720869365 |
Phone Number: | 8702656624 |
Fax Number: | |
NPI Enumeration Date: | 06/24/2015 |
NPI Last Update Date: | 06/24/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | A004425 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AR |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |