Healthcare Provider Details

I. General information

NPI: 1679308373
Provider Name (Legal Business Name): CHANNING JOHNSON ARNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 NW 114TH ST STE 255
CLIVE IA
50325-7036
US

IV. Provider business mailing address

PO BOX 674721
DALLAS TX
75267-4721
US

V. Phone/Fax

Practice location:
  • Phone: 515-461-9780
  • Fax: 515-461-9779
Mailing address:
  • Phone: 515-643-2519
  • Fax: 515-461-9779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA181114
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: