MEDICARE: JUDITH L JOHNSON CRNP

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	363L00000X	Nurse Practitioner	ARNP2188812	FL
2	363LF0000X	Family Nurse Practitioner	1-095402	AL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679576268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH L JOHNSON CRNP

Provider Business Mailing Address
First Line	:	1108 ROSS CLARK CIR
Second Line	:	HOSPITALIST OFFICE
City	:	DOTHAN
State	:	AL
Zip	:	36301-3022
Country	:	US
Telephone Number	:	334-712-3635
Fax Number	:	334-699-4387

Provider Business Practice Location Address
First Line	:	1108 ROSS CLARK CIR
Second Line	:	HOSPITALIST OFFICE
City	:	DOTHAN
State	:	AL
Zip	:	36301-3022
Country	:	US
Telephone Number	:	334-712-3635
Fax Number	:	334-699-4387

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	05/01/2024

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