Healthcare Provider Details

I. General information

NPI: 1538365267
Provider Name (Legal Business Name): MISTY NOWELL JOHNSON CCC-A, AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1994 GALLATIN PIKE N STE 200
MADISON TN
37115-2024
US

IV. Provider business mailing address

1994 GALLATIN PIKE N STE 200
MADISON TN
37115-2024
US

V. Phone/Fax

Practice location:
  • Phone: 615-851-9005
  • Fax: 615-851-9007
Mailing address:
  • Phone: 615-851-9005
  • Fax: 615-851-9007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberA1706
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA1706
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: