Basic Information
| Provider Information | |||||||||
| NPI: | 1316071624 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | CARRIE | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 DOMINION DR | ||||||||
| Address2: | |||||||||
| City: | WOODWAY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 767127556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2543464029 | ||||||||
| FaxNumber: | 8472216940 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 W STATE HIGHWAY 6 STE 140 | ||||||||
| Address2: | |||||||||
| City: | WACO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 767123787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1254301716 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 540630 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.