MEDICARE: MICHELLE LAURANE JOHNSON NP-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	363LF0000X	Family Nurse Practitioner	1070688	TX

General Provider Information

NPI Number	:	1801519087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE LAURANE JOHNSON NP-C

Provider Business Mailing Address
First Line	:	5701 BRYANT IRVIN RD STE 301
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4027
Country	:	US
Telephone Number	:	214-557-0530
Fax Number	:

Provider Business Practice Location Address
First Line	:	5701 BRYANT IRVIN RD STE 301
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4027
Country	:	US
Telephone Number	:	817-912-9800
Fax Number	:

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

Provider Enumeration Date	:	09/22/2022
Last Update Date	:	04/21/2023

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