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NPI Code Detail

MEDICARE: SHAVAUN JOHNSON NP

MEDICARE:   SHAVAUN  JOHNSON  NP
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner2024022030MO
2363LP0808XPsychiatric/Mental Health Nurse Practitioner251493AZ

General Provider Information

NPI Number : 1225624729
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAVAUN JOHNSON NP
Provider Business Mailing Address
First Line : 21168 E OCOTILLO RD # 1045
Second Line :
City : QUEEN CREEK
State : AZ
Zip : 85142-8175
Country : US
Telephone Number : 623-265-6220
Fax Number : 866-491-7389
Provider Business Practice Location Address
First Line : 21168 E OCOTILLO RD # 1045
Second Line :
City : QUEEN CREEK
State : AZ
Zip : 85142-8175
Country : US
Telephone Number : 623-265-6220
Fax Number : 866-491-7389
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/18/2020
Last Update Date : 12/28/2025

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