Healthcare Provider Details

I. General information

NPI: 1255667440
Provider Name (Legal Business Name): JEFFREY PAUL JOHNSON APN, FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2009
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N MAIN AVE
LOVINGTON NM
88260-2813
US

IV. Provider business mailing address

1600 N MAIN AVE
LOVINGTON NM
88260-2813
US

V. Phone/Fax

Practice location:
  • Phone: 575-396-6611
  • Fax:
Mailing address:
  • Phone: 575-396-6611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10141
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number61768
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number168340
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3061
License Number StateCO
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1056820
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: