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General NPI Number Information
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NPI Number | 1942744495
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Entity Type | Individual
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Provider Name | MELISSA KAY JOHNSON NP-C
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Gender | Female
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Dates
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Enumeration Date | 12/16/2016
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 5409 N KNOXVILLE AVE
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City | PEORIA
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State | IL
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Zip | 61614-5069
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Country | US
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Telephone | 309-691-1069
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Fax |
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Provider Business Mailing Address
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Address Line | 801 ILLINI DRIVE ECHO QC, LTD
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City | SILVIS
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State | IL
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Zip | 61282-1804
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Country | US
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Telephone | 309-281-4074
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | A130336
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F1216074
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License Number State | IL
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