Basic Information
| Provider Information | |||||||||
| NPI: | 1205160587 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | KARR | ||||||||
| MiddleName: | FARRELL | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7240 US HIGHWAY 158 E | ||||||||
| Address2: | |||||||||
| City: | LEASBURG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272919233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365042350 | ||||||||
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| Practice Location | |||||||||
| Address1: | 615 RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | ROXBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275734629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365992121 | ||||||||
| FaxNumber: | 3365035739 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2009 | ||||||||
| LastUpdateDate: | 01/20/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 86029 | NC | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 5004506 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.