Provider Demographics
NPI:1215452578
Name:JOHNSON, STACY (APRN-CNP)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 CHAPEL DR
Mailing Address - Street 2:
Mailing Address - City:MEXIA
Mailing Address - State:TX
Mailing Address - Zip Code:76667-3490
Mailing Address - Country:US
Mailing Address - Phone:254-562-2821
Mailing Address - Fax:254-562-1183
Practice Address - Street 1:540 CHAPEL DR
Practice Address - Street 2:
Practice Address - City:MEXIA
Practice Address - State:TX
Practice Address - Zip Code:76667-3490
Practice Address - Country:US
Practice Address - Phone:254-562-2821
Practice Address - Fax:254-562-1183
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX606779163W00000X
TXAP135193363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse