MEDICARE: ERICA S JOHNSON RN

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	163WE0003X	Emergency Registered Nurse	097766	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0	OTHER	AR	RN

General Provider Information

NPI Number	:	1235806704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA S JOHNSON RN

Provider Business Mailing Address
First Line	:	17208 E MAIL ROUTE RD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72206-6296
Country	:	US
Telephone Number	:	501-412-0788
Fax Number	:

Provider Business Practice Location Address
First Line	:	5020 NORTHSHORE DR
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72118-5324
Country	:	US
Telephone Number	:	501-748-8000
Fax Number	:

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

Provider Enumeration Date	:	08/24/2021
Last Update Date	:	08/24/2021

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