Provider Demographics
NPI:1306678248
Name:JOHNSON, SANDRA BELLE (CRNP, ACNP-AG)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:BELLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CRNP, ACNP-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 BOULDER CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-7523
Mailing Address - Country:US
Mailing Address - Phone:417-225-8335
Mailing Address - Fax:
Practice Address - Street 1:1613 N MCKENZIE ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2247
Practice Address - Country:US
Practice Address - Phone:251-949-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020002403163WC0200X, 163WF0300X, 163WG0600X
MO2000571341363LA2100X
AL1-203300363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WF0300XNursing Service ProvidersRegistered NurseFlight
No163WG0600XNursing Service ProvidersRegistered NurseGerontology