MEDICARE: MRS. PAMELA F JOHNSON 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	71002583A	IN

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	:	1588840052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PAMELA F JOHNSON FNP

Provider Business Mailing Address
First Line	:	104 E 7TH AVE
Second Line	:
City	:	CHADBOURN
State	:	NC
Zip	:	28431-1402
Country	:	US
Telephone Number	:	910-654-3143
Fax Number	:	910-654-4144

Provider Business Practice Location Address
First Line	:	104 E 7TH AVE
Second Line	:
City	:	CHADBOURN
State	:	NC
Zip	:	28431-1402
Country	:	US
Telephone Number	:	910-654-3143
Fax Number	:	910-654-4144

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

Provider Enumeration Date	:	01/15/2008
Last Update Date	:	10/07/2021

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