Healthcare Provider Details

I. General information

NPI: 1730653783
Provider Name (Legal Business Name): MIRANDA SUE JOST JOHNSON MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MIRANDA JOST MSN, APRN, FNP-C

II. Dates (important events)

Enumeration Date: 01/13/2019
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6743 I 30 E STE 203
ROYSE CITY TX
75189-4227
US

IV. Provider business mailing address

4215 JOE RAMSEY BLVD E
GREENVILLE TX
75401-7852
US

V. Phone/Fax

Practice location:
  • Phone: 469-707-6190
  • Fax: 469-707-6199
Mailing address:
  • Phone: 903-408-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1034185
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: