Provider Demographics
NPI:1154803609
Name:JOHNSON- LYKES, NATALIE NICOLE (APRN)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:NICOLE
Last Name:JOHNSON- LYKES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6600 KITTEN LAKE DR APT 1102
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31820-3784
Mailing Address - Country:US
Mailing Address - Phone:225-284-6677
Mailing Address - Fax:
Practice Address - Street 1:379 AL- 239
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:AL
Practice Address - Zip Code:36016
Practice Address - Country:US
Practice Address - Phone:334-775-3610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-31
Last Update Date:2024-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN221731363LF0000X
AL1-133314363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily