Healthcare Provider Details

I. General information

NPI: 1861116014
Provider Name (Legal Business Name): MRS. AMANDA JANE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2022
Last Update Date: 09/30/2022
Certification Date: 09/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W RANDOL MILL RD
ARLINGTON TX
76012-2504
US

IV. Provider business mailing address

5204 HIDDEN OAKS CT
ARLINGTON TX
76017-1277
US

V. Phone/Fax

Practice location:
  • Phone: 817-960-6100
  • Fax:
Mailing address:
  • Phone: 817-714-1413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number710964
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1089687
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: