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General NPI Number Information
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NPI Number | 1467286781
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Entity Type | Individual
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Provider Name | CRYSTAL JOHNSON RN, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/28/2024
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 17612 17TH ST STE A
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City | TUSTIN
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State | CA
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Zip | 92780-1962
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Country | US
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Telephone | 800-383-8180
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Fax |
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Provider Business Mailing Address
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Address Line | 17612 17TH ST STE A
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City | TUSTIN
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State | CA
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Zip | 92780-1962
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Country | US
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Telephone |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95031925
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95364126
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 274396
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License Number State | TN
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