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NPI Code Detail

MEDICARE: ROGER DALE JOHNSON FNP

MEDICARE: ROGER DALE JOHNSON FNP
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
1363LF0000XFamily Nurse PractitionerTN11991TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215975362
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROGER DALE JOHNSON FNP
Provider Business Mailing Address
First Line : 252 WORTHINGTON DR
Second Line :
City : KINGSPORT
State : TN
Zip : 37663-3180
Country : US
Telephone Number : 423-925-2600
Fax Number : 423-925-2600
Provider Business Practice Location Address
First Line : 207 E MYRTLE AVE
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37601-4633
Country : US
Telephone Number : 423-925-2600
Fax Number : 423-925-2600
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2006
Last Update Date : 04/30/2008

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