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General NPI Number Information
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NPI Number | 1548458920
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Entity Type | Individual
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Provider Name | THAIRA EVYLENN JOHNSON RN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/10/2007
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Last Update Date | 01/22/2009
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Provider Practice Location Address
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Address Line | 801 N TARRANT PKWY
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City | KELLER
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State | TX
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Zip | 76248-6860
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Country | US
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Telephone | 817-428-5558
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Fax |
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Provider Business Mailing Address
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Address Line | 3236 RIVERWOOD DR
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City | FORT WORTH
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State | TX
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Zip | 76116-9560
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Country | US
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Telephone | 817-738-1336
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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 | 236689
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License Number State | TX
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