MEDICARE: NEVA L. JOHNSON N.P.

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	4704224292	MI
2	363LA2200X	Adult Health Nurse Practitioner	4704224292	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4704224292	OTHER	MI	STATE OF MICHIGAN

General Provider Information

NPI Number	:	1700156783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEVA L. JOHNSON N.P.

Provider Business Mailing Address
First Line	:	529 M L KING AVE
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48502-2002
Country	:	US
Telephone Number	:	810-238-7226
Fax Number	:	810-239-5518

Provider Business Practice Location Address
First Line	:	529 M L KING AVE
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48502-2002
Country	:	US
Telephone Number	:	810-238-7226
Fax Number	:	810-239-5518

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

Provider Enumeration Date	:	01/06/2012
Last Update Date	:	04/28/2026

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