Healthcare Provider Details

I. General information

NPI: 1285644716
Provider Name (Legal Business Name): NELDA JOHNSON RNNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1 MEDICAL CENTER BLVD
LUFKIN TX
75904-3173
US

IV. Provider business mailing address

1 MEDICAL CENTER BLVD
LUFKIN TX
75904-3173
US

V. Phone/Fax

Practice location:
  • Phone: 936-637-2080
  • Fax: 936-637-7917
Mailing address:
  • Phone: 936-637-2080
  • Fax: 936-637-7917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number226130
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: