Healthcare Provider Details

I. General information

NPI: 1497660500
Provider Name (Legal Business Name): JOHNSON & BALLNER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2780 S JONES BLVD STE 221
LAS VEGAS NV
89146-5628
US

IV. Provider business mailing address

2780 S JONES BLVD STE 221
LAS VEGAS NV
89146-5628
US

V. Phone/Fax

Practice location:
  • Phone: 320-260-7472
  • Fax:
Mailing address:
  • Phone: 320-260-7472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DEREK JOHNSON
Title or Position: NURSE PRACTITIONER
Credential: NP, PMHNP
Phone: 320-260-7472