Healthcare Provider Details

I. General information

NPI: 1982104881
Provider Name (Legal Business Name): CHRISTY LYNN JOHNSON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTY LYNN MILLER PMHNP

II. Dates (important events)

Enumeration Date: 02/16/2018
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date: 10/18/2021
Reactivation Date: 10/26/2021

III. Provider practice location address

7400 ROPER LN
DAPHNE AL
36526-5274
US

IV. Provider business mailing address

5750A SOUTHLAND DR
MOBILE AL
36693-3316
US

V. Phone/Fax

Practice location:
  • Phone: 251-450-5916
  • Fax: 251-662-7297
Mailing address:
  • Phone: 251-450-5916
  • Fax: 251-662-7297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number902623
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-125961
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number902623
License Number StateMS
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1-125961
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: