Healthcare Provider Details

I. General information

NPI: 1376968842
Provider Name (Legal Business Name): JOANNA LYNN JOHNSON AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOANNA LYNN EMMONS ACNS-BC

II. Dates (important events)

Enumeration Date: 02/20/2014
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 SAINT MARYS DR STE 200
EVANSVILLE IN
47714
US

IV. Provider business mailing address

901 SAINT MARYS DR STE 200
EVANSVILLE IN
47714-0509
US

V. Phone/Fax

Practice location:
  • Phone: 812-485-6030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number71003702A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number71003702A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License Number71003702A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number71003702A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: