MEDICARE: WINDELL JOHNSON, P. A.

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	363L00000X	Nurse Practitioner
2	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1881204758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WINDELL JOHNSON, P. A.

Provider Business Mailing Address
First Line	:	7604 TOLTEC DR
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-4586
Country	:	US
Telephone Number	:	512-201-6766
Fax Number	:

Provider Business Practice Location Address
First Line	:	7500 DOLLARWAY RD STE 301
Second Line	:
City	:	WHITE HALL
State	:	AR
Zip	:	71602-3084
Country	:	US
Telephone Number	:	512-201-6766
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	HABIB KHAN
Credential	:
Telephone Number	:	512-201-6766

Provider Enumeration Date	:	08/05/2020
Last Update Date	:	12/16/2025

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