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General NPI Number Information
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NPI Number | 1245457670
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Entity Type | Individual
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Provider Name | AMANDA LYNN JOHNSON ACNP
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Gender | Female
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 04/27/2024
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Provider Practice Location Address
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Address Line | 2211 LOMAS BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-2719
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Country | US
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Telephone | 931-224-5383
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Fax |
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Provider Business Mailing Address
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Address Line | 495 FRANKLIN HEIGHTS DR
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City | WINCHESTER
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State | TN
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Zip | 37398-4679
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Country | US
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Telephone | 931-967-5113
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | APN0000007833
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 72339
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License Number State | NM
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