=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831613926
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TONYA LYNETTE JOHNSON CRNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2017
-----------------------------------------------------
Last Update Date | 07/31/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5243 OLD SPRINGVILLE RD STE 101
-----------------------------------------------------
City | PINSON
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35126-3674
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-228-0600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 608 RIDGE WAY
-----------------------------------------------------
City | PLEASANT GROVE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35127-1669
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-305-7273
-----------------------------------------------------
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 | 1-090844
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------