MEDICARE: MR. WINDELL LAMONT JOHNSON SR. 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
1	363L00000X	Nurse Practitioner	124247	AR
2	363LP2300X	Primary Care Nurse Practitioner	124247	AR

General Provider Information

NPI Number	:	1245877224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WINDELL LAMONT JOHNSON SR. FNP

Provider Business Mailing Address
First Line	:	7604 TOLTEC DR
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-4586
Country	:	US
Telephone Number	:	512-201-6766
Fax Number	:

Provider Business Practice Location Address
First Line	:	7500 DOLLARWAY RD STE 301
Second Line	:
City	:	WHITE HALL
State	:	AR
Zip	:	71602-3084
Country	:	US
Telephone Number	:	512-201-6766
Fax Number	:

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

Provider Enumeration Date	:	12/09/2019
Last Update Date	:	12/16/2025

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