Provider Demographics
NPI:1326846833
Name:JOHNSON, TRACIE LYNN (DNP, RN-BC)
Entity type:Individual
Prefix:DR
First Name:TRACIE
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:
Credentials:DNP, RN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4183 WOOD ACRE DR
Mailing Address - Street 2:
Mailing Address - City:BELLBROOK
Mailing Address - State:OH
Mailing Address - Zip Code:45305-1342
Mailing Address - Country:US
Mailing Address - Phone:937-623-2900
Mailing Address - Fax:
Practice Address - Street 1:4183 WOOD ACRE DR
Practice Address - Street 2:
Practice Address - City:BELLBROOK
Practice Address - State:OH
Practice Address - Zip Code:45305-1342
Practice Address - Country:US
Practice Address - Phone:937-623-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376J00000X, 3747P1801X
OHRR485604172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver