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General NPI Number Information
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NPI Number | 1184037681
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Entity Type | Individual
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Provider Name | TERESA ANNE JOHNSON NP-C
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Gender | Female
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Dates
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Enumeration Date | 06/03/2014
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Last Update Date | 04/22/2015
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Provider Practice Location Address
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Address Line | 105 N GRAND ST STE 2
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City | GREENFIELD
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State | MO
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Zip | 65661-8198
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Country | US
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Telephone | 417-637-5133
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 94
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City | ARCOLA
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State | MO
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Zip | 65603-0094
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Country | US
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Telephone | 417-424-1009
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2014016132
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License Number State | MO
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