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NPI Code Detail

MEDICARE: HEATHER N JOHNSON RN

MEDICARE: HEATHER N 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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAP70075125WA
2363LP0808XPsychiatric/Mental Health Nurse Practitioner10054864OR

General Provider Information

NPI Number : 1619672557
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER N JOHNSON RN
Provider Business Mailing Address
First Line : 915 NW VINCA LN
Second Line :
City : CAMAS
State : WA
Zip : 98607-7914
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 13535 SW 72ND AVE STE 170
Second Line :
City : PORTLAND
State : OR
Zip : 97223-8074
Country : US
Telephone Number : 971-300-0654
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2023
Last Update Date : 02/18/2026

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