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: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

458 DOSS FERRY PKWY
KIMBERLY AL
35091-2032
US

IV. Provider business mailing address

458 DOSS FERRY PKWY
KIMBERLY AL
35091-2032
US

V. Phone/Fax

Practice location:
  • Phone: 205-240-5953
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-138118
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: