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NPI Code Detail

MEDICARE: EMILY K JOHNSON NP

MEDICARE: EMILY K JOHNSON NP
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
1363L00000XNurse PractitionerR197354-7MN
2363LP0808XPsychiatric/Mental Health Nurse PractitionerG184427IA
3363L00000XNurse Practitioner156MN

General Provider Information

NPI Number : 1134435167
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY K JOHNSON NP
Provider Business Mailing Address
First Line : 1900 SILVER LAKE RD NW STE 110
Second Line :
City : NEW BRIGHTON
State : MN
Zip : 55112-1789
Country : US
Telephone Number : 651-628-9566
Fax Number : 651-628-0411
Provider Business Practice Location Address
First Line : 1105 N ANKENY BLVD STE 100
Second Line :
City : ANKENY
State : IA
Zip : 50023-4003
Country : US
Telephone Number : 515-255-8399
Fax Number : 515-644-8225
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2010
Last Update Date : 08/22/2025

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