MEDICARE: CRYSTAL R JOHNSON FNP

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	363LF0000X	Family Nurse Practitioner	696808	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548560220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL R JOHNSON FNP

Provider Business Mailing Address
First Line	:	11215 COPPER SHORES LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-1675
Country	:	US
Telephone Number	:	832-660-1256
Fax Number	:

Provider Business Practice Location Address
First Line	:	11215 COPPER SHORES LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-1675
Country	:	US
Telephone Number	:	183-266-0125
Fax Number	:

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

Provider Enumeration Date	:	10/27/2010
Last Update Date	:	08/16/2023

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