MEDICARE: GRACIE BETH JOHNSON APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	260709	TN
2	363LF0000X	Family Nurse Practitioner	0024196408	VA

General Provider Information

NPI Number	:	1124970942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACIE BETH JOHNSON APRN

Provider Business Mailing Address
First Line	:	4600 MONTGOMERY RD STE 400
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-2600
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5357 HENNEMAN DR
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23513-2401
Country	:	US
Telephone Number	:	833-510-4357
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2026
Last Update Date	:	06/15/2026

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