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General NPI Number Information
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NPI Number | 1154213460
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Entity Type | Individual
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Provider Name | MARISA JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 07/21/2025
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 812 GREENWOOD AVE
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City | CLARKSVILLE
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State | TN
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Zip | 37040-4068
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Country | US
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Telephone | 888-277-4137
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Fax |
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Provider Business Mailing Address
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Address Line | 401 VICTORY RD APT 1N
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City | CLARKSVILLE
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State | TN
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Zip | 37042-2948
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Country | US
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Telephone |
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Fax |
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 0001318711
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License Number State | VA
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