MEDICARE: CYNTHIA LYNETTE JOHNSON PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	901858	MS
2	363L00000X	Nurse Practitioner	901858	MS

General Provider Information

NPI Number	:	1205350410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA LYNETTE JOHNSON PMHNP-BC

Provider Business Mailing Address
First Line	:	180B DEBUYS RD
Second Line	:
City	:	BILOXI
State	:	MS
Zip	:	39531-4404
Country	:	US
Telephone Number	:	228-806-7030
Fax Number	:	228-594-1765

Provider Business Practice Location Address
First Line	:	180B DEBUYS RD
Second Line	:
City	:	BILOXI
State	:	MS
Zip	:	39531-4404
Country	:	US
Telephone Number	:	228-806-7030
Fax Number	:	228-594-1765

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

Provider Enumeration Date	:	07/29/2017
Last Update Date	:	03/02/2026

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