MEDICARE: MRS. ANGELA 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	163WW0000X	Wound Care Registered Nurse	RD100377	TN
2	363LF0000X	Family Nurse Practitioner	APN6998	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	TN0100	OTHER	JOHN DEERE PROVIDER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	4062794	OTHER	BLUE CROSS PROVIDER

General Provider Information

NPI Number	:	1912951005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA JOHNSON FNP

Provider Business Mailing Address
First Line	:	PO BOX 37087
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21297-3087
Country	:	US
Telephone Number	:	828-687-5616
Fax Number	:	828-650-8076

Provider Business Practice Location Address
First Line	:	438 E VANN RD
Second Line	:	SUITE 202
City	:	GREENEVILLE
State	:	TN
Zip	:	37743-7202
Country	:	US
Telephone Number	:	423-278-1712
Fax Number	:	423-278-1703

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

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	10/05/2022

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