Provider Demographics
NPI:1316071624
Name:JOHNSON, CARRIE ANN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DOMINION DR
Mailing Address - Street 2:
Mailing Address - City:WOODWAY
Mailing Address - State:TX
Mailing Address - Zip Code:76712-7556
Mailing Address - Country:US
Mailing Address - Phone:254-346-4029
Mailing Address - Fax:847-221-6940
Practice Address - Street 1:15190 BADGER RANCH BLVD STE 102
Practice Address - Street 2:
Practice Address - City:WOODWAY
Practice Address - State:TX
Practice Address - Zip Code:76712-8984
Practice Address - Country:US
Practice Address - Phone:254-301-7166
Practice Address - Fax:254-824-3297
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX540630363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily