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General NPI Number Information
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NPI Number | 1053640656
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Entity Type | Individual
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Provider Name | PATRICE JOHNELL MSN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 12/10/2009
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Last Update Date | 10/19/2020
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Provider Practice Location Address
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Address Line | 21610 PACIFIC HWY
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City | OCEAN PARK
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State | WA
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Zip | 98640-9864
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Country | US
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Telephone | 360-665-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 4468 CLIPPER CV
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City | DESTIN
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State | FL
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Zip | 32541-3699
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Country | US
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Telephone | 970-371-7120
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Fax | 850-650-3774
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN-128942
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN-9246598
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP-10143
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP60697111
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License Number State | WA
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