=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013565183
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROLYN LEE JOHNSON ARNP, CNM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2019
-----------------------------------------------------
Last Update Date | 05/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 106 PLAZA DR SE BLDG C1
-----------------------------------------------------
City | YELM
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98597-8841
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-370-6987
-----------------------------------------------------
Fax | 253-248-0671
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12238 KOEPPEN RD SE
-----------------------------------------------------
City | RAINIER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98576-9641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-973-8744
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367A00000X
-----------------------------------------------------
Taxonomy Name | Advanced Practice Midwife
-----------------------------------------------------
License Number | AP61580533
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------