=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558649723
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | APRIL R JOHNSON FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2011
-----------------------------------------------------
Last Update Date | 04/09/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 461 TUSCUMBIA CV W
-----------------------------------------------------
City | COLLIERVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38017-3659
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-210-2061
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1766
-----------------------------------------------------
City | COLLIERVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38027-1766
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-210-2061
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 15921
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------