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General NPI Number Information
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NPI Number | 1467752915
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Entity Type | Individual
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Provider Name | JASON BRADLEY JOHNSON NP-C
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Gender | Male
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Dates
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Enumeration Date | 11/01/2010
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 8101 S BROADWAY AVE
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City | TYLER
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State | TX
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Zip | 75703-5469
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Country | US
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Telephone | 903-939-7500
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Fax | 903-939-7728
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Provider Business Mailing Address
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Address Line | 4700 SETON CENTER PKWY STE 115
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City | AUSTIN
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State | TX
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Zip | 78759-5753
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 714451
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 163WR0006X
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Taxonomy Name | Registered Nurse First Assistant
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License Number | AP119683
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License Number State | TX
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