Healthcare Provider Details

I. General information

NPI: 1104133065
Provider Name (Legal Business Name): FERNANDA LEITE JOHNSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2010
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2183 W MAIN ST # A209
LEHI UT
84043-6760
US

IV. Provider business mailing address

6497 VANHOVEN CREST ST
LAS VEGAS NV
89166-2016
US

V. Phone/Fax

Practice location:
  • Phone: 385-469-2120
  • Fax:
Mailing address:
  • Phone: 615-668-4665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number32187
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number870445
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number13423930-4405
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9552826
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: