=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386901254
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTY JOHNSON APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2012
-----------------------------------------------------
Last Update Date | 02/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | BLDG 69 DOGWOOD AVENUE
-----------------------------------------------------
City | MOUNTAIN HOME
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37684-4000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-926-1171
-----------------------------------------------------
Fax | 423-979-3483
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | BLDG 69 DOGWOOD AVENUE
-----------------------------------------------------
City | MOUNTAIN HOME
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37684-4000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-926-1171
-----------------------------------------------------
Fax | 423-979-3483
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 3007392
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 0000024052
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------