| Doctor Name: | CARLSON BRYAN JOHNSON |
| NPI Number: | 1669871497 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | FNP |
| License Number: | 5007104 |
| Business Practice Address: | 4923 S Croatan Hwy Nags Head, NC - 279599709 |
| Business Phone Number: | 2522618040 |
| Business Fax Number: | 2524417041 |
| Mailing Address: | 1134 N Road St, Building 9 ELIZABETH CITY |
| State: | NC |
| Postal Code: | 279093365 |
| Phone Number: | 2523389451 |
| Fax Number: | 2523389170 |
| NPI Enumeration Date: | 08/18/2014 |
| NPI Last Update Date: | 08/18/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 5007104 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |