Healthcare Provider Details

I. General information

NPI: 1992569974
Provider Name (Legal Business Name): ASHLEY JOHNSON APRN, NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5950 SARATOGA BLVD
CORPUS CHRISTI TX
78414-4100
US

IV. Provider business mailing address

1141 IMPERIAL ST
PORTLAND TX
78374-4225
US

V. Phone/Fax

Practice location:
  • Phone: 361-694-1630
  • Fax:
Mailing address:
  • Phone: 254-723-1976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number1152593
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: