Healthcare Provider Details

I. General information

NPI: 1205160587
Provider Name (Legal Business Name): KARR FARRELL JOHNSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2009
Last Update Date: 01/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 RIDGE RD
ROXBORO NC
27573-4629
US

IV. Provider business mailing address

7240 US HIGHWAY 158 E
LEASBURG NC
27291-9233
US

V. Phone/Fax

Practice location:
  • Phone: 336-599-2121
  • Fax: 336-503-5739
Mailing address:
  • Phone: 336-504-2350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number86029
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5004506
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: