Healthcare Provider Details

I. General information

NPI: 1396500575
Provider Name (Legal Business Name): ABBY JOHNSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2024
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 E SUMMIT ST
RED OAK IA
51566-1706
US

IV. Provider business mailing address

1400 SENATE AVE STE 108
RED OAK IA
51566-1271
US

V. Phone/Fax

Practice location:
  • Phone: 712-621-5492
  • Fax:
Mailing address:
  • Phone: 712-623-7250
  • Fax: 712-623-7257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA184359
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1106455
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: