Healthcare Provider Details

I. General information

NPI: 1922404698
Provider Name (Legal Business Name): SHYRETHA JOHNSON APRN, BC PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2014
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 NUUANU AVE STE 1
HONOLULU HI
96817-5190
US

IV. Provider business mailing address

928 NUUANU AVE STE 1
HONOLULU HI
96817-5190
US

V. Phone/Fax

Practice location:
  • Phone: 808-777-9460
  • Fax: 808-217-9174
Mailing address:
  • Phone: 808-777-9460
  • Fax: 808-217-9174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1088061
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: