MEDICARE: TODD A JOHNSON FNP-C

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	AP138408	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP138408	OTHER	TX	TEXAS BON

General Provider Information

NPI Number	:	1780166090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD A JOHNSON FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 844658
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-4658
Country	:	US
Telephone Number	:	254-724-2111
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 S 31ST ST
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76508-5300
Country	:	US
Telephone Number	:	254-724-2111
Fax Number	:

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

Provider Enumeration Date	:	09/04/2018
Last Update Date	:	09/12/2022

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