DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: THOMAS JOHNSON III APRN, CNP

MEDICARE: THOMAS JOHNSON III APRN, CNP
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
1163W00000XRegistered NurseR 179591-6MN
2363LP0808XPsychiatric/Mental Health Nurse Practitioner2950MN

General Provider Information

NPI Number : 1609051168
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOMAS JOHNSON III APRN, CNP
Provider Business Mailing Address
First Line : 516 S POKEGAMA AVE
Second Line :
City : GRAND RAPIDS
State : MN
Zip : 55744-3820
Country : US
Telephone Number : 218-302-4468
Fax Number : 218-302-1457
Provider Business Practice Location Address
First Line : 516 S POKEGAMA AVE
Second Line :
City : GRAND RAPIDS
State : MN
Zip : 55744-3820
Country : US
Telephone Number : 218-327-2001
Fax Number : 218-302-1457
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2008
Last Update Date : 11/29/2023

Similar Medicare Providers

1407009384 — MS. JODY MURPHY PMHNP-BC
Practice Location Address:
516 S POKEGAMA AVE
GRAND RAPIDS, MN
55744-3820
Practice Phone: 218-327-2001
Practice Fax: 218-327-0456
1518548858 — HEATHER STUBER PMHNP
Practice Location Address:
516 S POKEGAMA AVE
GRAND RAPIDS, MN
55744-3820
Practice Phone: 218-327-2001
Practice Fax: 218-327-0456
1760150213 — DIANE ELIZABETH TYLER
Practice Location Address:
516 S POKEGAMA AVE
GRAND RAPIDS, MN
55744-3820
Practice Phone: 218-327-2001
Practice Fax:
1366100182 — ROGER P WATTS
Practice Location Address:
516 S POKEGAMA AVE
GRAND RAPIDS, MN
55744-3820
Practice Phone: 218-327-2001
Practice Fax: 218-327-0456
1477211191 — TIERNEY GILGE
Practice Location Address:
516 S POKEGAMA AVE
GRAND RAPIDS, MN
55744-3820
Practice Phone: 218-327-2001
Practice Fax: 218-327-0456
1366196115 — DIANE DEBRA LEADERS MSW, LICSW
Practice Location Address:
516 S POKEGAMA AVE
GRAND RAPIDS, MN
55744-3820
Practice Phone: 218-327-2001
Practice Fax:

Directions to “ THOMAS JOHNSON III APRN, CNP” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.