Healthcare Provider Details

I. General information

NPI: 1639543135
Provider Name (Legal Business Name): SHAWNA MARIE JOHNSTON NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2015
Last Update Date: 11/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3936 GRIZZLY HILLS CIR
FORT WORTH TX
76244-7482
US

IV. Provider business mailing address

3936 GRIZZLY HILLS CIR
FORT WORTH TX
76244-7482
US

V. Phone/Fax

Practice location:
  • Phone: 972-567-7768
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAP129279
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: