Healthcare Provider Details

I. General information

NPI: 1952954141
Provider Name (Legal Business Name): HEATHER JOHNS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 SUNSET BLVD
CONRAD MT
59425-1717
US

IV. Provider business mailing address

523 8TH AVE SW
CONRAD MT
59425-2602
US

V. Phone/Fax

Practice location:
  • Phone: 406-271-3211
  • Fax:
Mailing address:
  • Phone: 406-289-0740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number145866
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: