Healthcare Provider Details

I. General information

NPI: 1841143484
Provider Name (Legal Business Name): MARCUS ALLAN JOHNSON PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2026
Last Update Date: 02/16/2026
Certification Date: 02/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3108 N AURORA AVE
SIOUX FALLS SD
57107-2007
US

IV. Provider business mailing address

3108 N AURORA AVE
SIOUX FALLS SD
57107-2007
US

V. Phone/Fax

Practice location:
  • Phone: 605-408-0159
  • Fax:
Mailing address:
  • Phone: 605-408-0159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2026004356
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: