Healthcare Provider Details

I. General information

NPI: 1801435607
Provider Name (Legal Business Name): MELISSA ANNE JOHNSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2019
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17151 ISLAND LOOP WAY
BEND OR
97707-2209
US

IV. Provider business mailing address

17151 ISLAND LOOP WAY
BEND OR
97707-2209
US

V. Phone/Fax

Practice location:
  • Phone: 360-927-0878
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61346876
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP10055957
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN10055957
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN60562796
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: