MEDICARE: MRS. NATALIE RENEE JOHNSON PA C

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	363A00000X	Physician Assistant	PA04361	TX
2	363AM0700X	Medical Physician Assistant	PA.0004285	CO
3	363A00000X	Physician Assistant	PA.0004285	CO

General Provider Information

NPI Number	:	1760688733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NATALIE RENEE JOHNSON PA C

Provider Business Mailing Address
First Line	:	4360 MONTEBELLO DR STE 900
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-7210
Country	:	US
Telephone Number	:	719-388-1594
Fax Number	:	719-388-1595

Provider Business Practice Location Address
First Line	:	4360 MONTEBELLO DR STE 900
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-7210
Country	:	US
Telephone Number	:	719-388-1594
Fax Number	:	719-388-1595

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

Provider Enumeration Date	:	06/26/2007
Last Update Date	:	08/28/2023

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