Healthcare Provider Details

I. General information

NPI: 1568305902
Provider Name (Legal Business Name): RUSTI LYNN JOHNSON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 HIGHWAY 78 E STE 316
JASPER AL
35501-8951
US

IV. Provider business mailing address

3500 BLUE LAKE DR STE 495
VESTAVIA AL
35243-1975
US

V. Phone/Fax

Practice location:
  • Phone: 205-385-7860
  • Fax: 205-385-7861
Mailing address:
  • Phone: 205-385-7860
  • Fax: 205-385-7861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-138118
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-138118
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: