=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730242306
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BARBARA S JOHNSON PMHNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2006
-----------------------------------------------------
Last Update Date | 10/05/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 RIVER OAKS DR STE 140
-----------------------------------------------------
City | SOUTHLAKE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76092-6845
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-778-8884
-----------------------------------------------------
Fax | 817-385-6540
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 RIVER OAKS DR STE 140
-----------------------------------------------------
City | SOUTHLAKE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76092-6845
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-778-8884
-----------------------------------------------------
Fax | 817-385-6540
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 423882
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------