MEDICARE: MARISSA JOHNSON NBC-WHC

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	171400000X	Health & Wellness Coach	A3630981	TN

General Provider Information

NPI Number	:	1205602125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA JOHNSON NBC-WHC

Provider Business Mailing Address
First Line	:	888 CHERRY BLOSSOM LN
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37040-6239
Country	:	US
Telephone Number	:	256-770-2550
Fax Number	:

Provider Business Practice Location Address
First Line	:	888 CHERRY BLOSSOM LN
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37040-6239
Country	:	US
Telephone Number	:	256-770-2550
Fax Number	:

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

Provider Enumeration Date	:	12/01/2023
Last Update Date	:	06/28/2025

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