Healthcare Provider Details

I. General information

NPI: 1982666129
Provider Name (Legal Business Name): WILLIAM J JOHNSON JR. FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 SOUTH MILLER SUITE C E F
ROCKAWAY BEACH OR
97136
US

IV. Provider business mailing address

PO BOX 489
TILLAMOOK OR
97141
US

V. Phone/Fax

Practice location:
  • Phone: 503-355-2700
  • Fax: 503-355-2702
Mailing address:
  • Phone: 503-842-3900
  • Fax: 503-842-3903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: