Healthcare Provider Details

I. General information

NPI: 1043652217
Provider Name (Legal Business Name): LISA LYNN JOHNSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W 12TH AVE
EMPORIA KS
66801-2504
US

IV. Provider business mailing address

2600 OTTAWA RD P.O. BOX 360
NEODESHA KS
66757-1897
US

V. Phone/Fax

Practice location:
  • Phone: 620-343-6800
  • Fax: 620-341-7821
Mailing address:
  • Phone: 620-325-2611
  • Fax: 620-325-8460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number76144
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: