Healthcare Provider Details

I. General information

NPI: 1922338086
Provider Name (Legal Business Name): VICKIE M JOHNSON NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 JUDGES RD STE 4E
WILMINGTON NC
28405-3655
US

IV. Provider business mailing address

PO BOX 22403
BELFAST ME
04915-4476
US

V. Phone/Fax

Practice location:
  • Phone: 910-791-6767
  • Fax: 910-399-2190
Mailing address:
  • Phone: 888-402-7256
  • Fax: 888-902-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number13530
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number13530
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5022905
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: