Healthcare Provider Details

I. General information

NPI: 1346447190
Provider Name (Legal Business Name): LEIF BRYNOLF JOHNSON PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LEIF BRYNOLF JOHNSON PMHNP

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 REDDICK RD
ASHEVILLE NC
28805-2717
US

IV. Provider business mailing address

158 ZILLICOA ST
ASHEVILLE NC
28801-1079
US

V. Phone/Fax

Practice location:
  • Phone: 828-298-0186
  • Fax: 828-298-4870
Mailing address:
  • Phone: 828-254-9494
  • Fax: 828-298-4870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5002627
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number213163
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: