Healthcare Provider Details

I. General information

NPI: 1497844203
Provider Name (Legal Business Name): SABRINA M JOHNSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 HARPER DR NE # DE
ALBUQUERQUE NM
87109-3587
US

IV. Provider business mailing address

PO BOX 26666
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-823-8870
  • Fax: 505-823-8875
Mailing address:
  • Phone: 505-225-2500
  • Fax: 505-225-2025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2005-0037
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: