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General NPI Number Information
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NPI Number | 1952754442
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Entity Type | Individual
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Provider Name | NATHAN PATRICK JOHNSON PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 07/19/2016
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 4035 12TH ST CUTOFF SE STE 120
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City | SALEM
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State | OR
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Zip | 97302
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Country | US
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Telephone | 971-304-9306
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Fax | 503-926-6624
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Provider Business Mailing Address
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Address Line | PO BOX 12926
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City | SALEM
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State | OR
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Zip | 97309-0926
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Country | US
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Telephone | 971-304-9306
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Fax | 503-926-6624
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 209338
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 201701389RN
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 201701390NPPP
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License Number State | OR
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0000022011
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License Number State | TN
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 201701390NP-PP
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License Number State | OR
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