MEDICARE: TODD HAROLD ST. JOHN 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	363LF0000X	Family Nurse Practitioner	5004162	NC
2	363L00000X	Nurse Practitioner	5004162	NC

General Provider Information

NPI Number	:	1457506909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD HAROLD ST. JOHN FNP

Provider Business Mailing Address
First Line	:	360 PARKWOOD MEDICAL PARK
Second Line	:
City	:	ELKIN
State	:	NC
Zip	:	28621-2444
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	546 WINSTON RD
Second Line	:
City	:	JONESVILLE
State	:	NC
Zip	:	28642-2217
Country	:	US
Telephone Number	:	336-526-0037
Fax Number	:

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

Provider Enumeration Date	:	11/25/2008
Last Update Date	:	06/06/2025

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