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General NPI Number Information
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NPI Number | 1356484596
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Entity Type | Individual
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Provider Name | NICKLETT R JOHNSTON NP
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Gender | Female
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 08/23/2018
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Provider Practice Location Address
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Address Line | 688 W 4TH ST STE B
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City | BENSON
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State | AZ
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Zip | 85602
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Country | US
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Telephone | 520-720-6551
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Fax | 520-720-6552
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Provider Business Mailing Address
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Address Line | 688 W 4TH ST STE B
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City | BENSON
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State | AZ
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Zip | 85602-6315
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Country | US
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Telephone | 520-720-6551
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Fax | 520-720-6552
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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 | 546098
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License Number State | TX
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