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General NPI Number Information
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NPI Number | 1336608009
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Entity Type | Individual
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Provider Name | SHELBY LEE JOHNSON APRN, AGACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/13/2019
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 1540 E FRONT ST STE 100
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City | CLAYTON
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State | NC
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Zip | 27527-6126
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Country | US
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Telephone | 919-827-1625
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Fax |
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Provider Business Mailing Address
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Address Line | 20 PUBLIX DRIVE STE 104 #107
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City | CLAYTON
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State | NC
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Zip | 27527-9363
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Country | US
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Telephone | 919-827-1625
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP13363
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License Number State | VI
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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 | 5014122
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License Number State | NC
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