Healthcare Provider Details

I. General information

NPI: 1477426906
Provider Name (Legal Business Name): WHITNEY NICOLE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 SUMMERHILL DR
PINE BLUFF AR
71603-8244
US

IV. Provider business mailing address

7801 SUMMERHILL DR
PINE BLUFF AR
71603-8244
US

V. Phone/Fax

Practice location:
  • Phone: 870-395-0078
  • Fax:
Mailing address:
  • Phone: 870-395-0078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: