MEDICARE: CHRISTOPHER JOHNSON FNP-BC

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	A004425	AR

Other Identifiers

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

General Provider Information

NPI Number	:	1578945770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER JOHNSON FNP-BC

Provider Business Mailing Address
First Line	:	2918 LOUIS SESSIONS ST
Second Line	:
City	:	LAKE VILLAGE
State	:	AR
Zip	:	71653-6049
Country	:	US
Telephone Number	:	870-265-5343
Fax Number	:	870-265-5686

Provider Business Practice Location Address
First Line	:	2918 LOUIS SESSIONS ST
Second Line	:
City	:	LAKE VILLAGE
State	:	AR
Zip	:	71653-6049
Country	:	US
Telephone Number	:	870-265-5343
Fax Number	:	870-265-5686

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

Provider Enumeration Date	:	06/24/2015
Last Update Date	:	03/05/2019

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