Healthcare Provider Details

I. General information

NPI: 1912951005
Provider Name (Legal Business Name): ANGELA JOHNSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 E VANN RD SUITE 202
GREENEVILLE TN
37743-7202
US

IV. Provider business mailing address

PO BOX 37087
BALTIMORE MD
21297-3087
US

V. Phone/Fax

Practice location:
  • Phone: 423-278-1712
  • Fax: 423-278-1703
Mailing address:
  • Phone: 828-687-5616
  • Fax: 828-650-8076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberRD100377
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN6998
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: