Healthcare Provider Details

I. General information

NPI: 1932013521
Provider Name (Legal Business Name): CHRISTOPHER EDWARD JOHNSON CHW1-6702
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 S JONES BLVD
LAS VEGAS NV
89146-5398
US

IV. Provider business mailing address

2740 S JONES BLVD
LAS VEGAS NV
89146-5398
US

V. Phone/Fax

Practice location:
  • Phone: 702-248-8866
  • Fax: 702-248-1339
Mailing address:
  • Phone: 702-248-8866
  • Fax: 702-248-1336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCHW1-6702
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: