MEDICARE: DANIEL PATRICK JOHNSON APRN

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	AP0000028116	TN

General Provider Information

NPI Number	:	1801402631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL PATRICK JOHNSON APRN

Provider Business Mailing Address
First Line	:	1810 SINKING SPRINGS RD
Second Line	:
City	:	MIDWAY
State	:	TN
Zip	:	37809-5003
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2428 KNOB CREEK RD STE 102
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-2396
Country	:	US
Telephone Number	:	423-794-1074
Fax Number	:	423-794-1079

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

Provider Enumeration Date	:	09/17/2020
Last Update Date	:	10/29/2021

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