Provider Demographics
NPI:1063077295
Name:JOHNSON, MARTHA LYNNETTE (FNP-BC)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:LYNNETTE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8145 HWY 6 S
Mailing Address - Street 2:SUITE 112 PBM 1026
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083
Mailing Address - Country:US
Mailing Address - Phone:832-536-6055
Mailing Address - Fax:713-347-6924
Practice Address - Street 1:10834 BRADFORD WAY DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77075-2362
Practice Address - Country:US
Practice Address - Phone:832-536-6055
Practice Address - Fax:713-347-6924
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136761363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP136761OtherTEXAS BOARD OF NURSING