Basic Information
| Provider Information | |||||||||
| NPI: | 1821608241 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | MARISSA | ||||||||
| MiddleName: | KAE | ||||||||
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| Credential: | APRN-CNP,FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3111 SWARTZEL RD | ||||||||
| Address2: | |||||||||
| City: | FARMERSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453258222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373079699 | ||||||||
| FaxNumber: | 8442495579 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 S 3RD ST STE 210 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432154206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8334455998 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2020 | ||||||||
| LastUpdateDate: | 12/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN.CNP.0027252 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.