Healthcare Provider Details

I. General information

NPI: 1205704590
Provider Name (Legal Business Name): HEATHER LEANN JOHNSON APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2025
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2713 S 74TH ST STE 302
FORT SMITH AR
72903-5155
US

IV. Provider business mailing address

PO BOX 776084
CHICAGO IL
60677-6084
US

V. Phone/Fax

Practice location:
  • Phone: 479-573-3800
  • Fax: 479-573-3814
Mailing address:
  • Phone: 479-573-3800
  • Fax: 479-573-3814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number235191
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: