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NPI Code Detail

MEDICARE: LISA HENRY-JOHNSON PMHNP-BC

MEDICARE: LISA HENRY-JOHNSON PMHNP-BC
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
1163W00000XRegistered Nurse756186TX
2363L00000XNurse Practitioner1077291TX

General Provider Information

NPI Number : 1861605214
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA HENRY-JOHNSON PMHNP-BC
Provider Business Mailing Address
First Line : 6800 PARK TEN BLVD STE 200S
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78213-4293
Country : US
Telephone Number : 210-834-1100
Fax Number :
Provider Business Practice Location Address
First Line : 1 HAVEN FOR HOPE WAY
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78207-1266
Country : US
Telephone Number : 210-220-2100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2007
Last Update Date : 08/15/2024

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