Healthcare Provider Details

I. General information

NPI: 1730890831
Provider Name (Legal Business Name): LAURA JOHNSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2022
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 WARD DR STE 101A
MURFREESBORO TN
37129-0558
US

IV. Provider business mailing address

160 SILVER MAPLE ST
LENOIR CITY TN
37771-2012
US

V. Phone/Fax

Practice location:
  • Phone: 615-728-3876
  • Fax:
Mailing address:
  • Phone: 865-804-0921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number33055
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: