Healthcare Provider Details

I. General information

NPI: 1275075897
Provider Name (Legal Business Name): PATRICK JOHNSON RN-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 PARAGON PKWY STE 800
CLYDE NC
28721-9465
US

IV. Provider business mailing address

157 PARAGON PKWY STE 800
CLYDE NC
28721-9465
US

V. Phone/Fax

Practice location:
  • Phone: 828-356-2244
  • Fax: 828-356-1115
Mailing address:
  • Phone: 828-356-2244
  • Fax: 828-356-1115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number274058
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: