Healthcare Provider Details

I. General information

NPI: 1417395476
Provider Name (Legal Business Name): KRISTIE LYNN JOHNSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2013
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 E TYLER ST
ATHENS TX
75751-2145
US

IV. Provider business mailing address

777 NW 63RD ST FL 2
OKLAHOMA CITY OK
73116-7601
US

V. Phone/Fax

Practice location:
  • Phone: 903-292-5015
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP140017
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: