MEDICARE: MRS. COURTNEY KATE 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	RN181532	GA

General Provider Information

NPI Number	:	1679824551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. COURTNEY KATE JOHNSON FNP

Provider Business Mailing Address
First Line	:	1900 11TH AVE STE A
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-1868
Country	:	US
Telephone Number	:	706-323-3400
Fax Number	:	706-321-1684

Provider Business Practice Location Address
First Line	:	1900 11TH AVE STE A
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-1868
Country	:	US
Telephone Number	:	706-323-3400
Fax Number	:	706-321-1684

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

Provider Enumeration Date	:	10/02/2012
Last Update Date	:	10/02/2012

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