Healthcare Provider Details

I. General information

NPI: 1225006943
Provider Name (Legal Business Name): SALLY PATRICIA JOHNSON RNC/WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100F W DEAN KEATON ST UNIVERSITY HEALTH SERVICES
AUSTIN TX
78712-1006
US

IV. Provider business mailing address

11909 ALOE VERA TRL
AUSTIN TX
78750-1386
US

V. Phone/Fax

Practice location:
  • Phone: 512-475-8216
  • Fax:
Mailing address:
  • Phone: 512-258-7539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number433504
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: