MEDICARE: WILLIAM TALBOT JOHNSON FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	741383	TX
2	363LF0000X	Family Nurse Practitioner	AP120283	TX

General Provider Information

NPI Number	:	1063797298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM TALBOT JOHNSON FNP-BC

Provider Business Mailing Address
First Line	:	16107 KENSINGTON DR STE 126
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-4224
Country	:	US
Telephone Number	:	281-201-0657
Fax Number	:	281-336-0764

Provider Business Practice Location Address
First Line	:	15882 CHAMPION FOREST DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-7141
Country	:	US
Telephone Number	:	281-809-6615
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2011
Last Update Date	:	06/16/2021

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