Provider Demographics
NPI:1366180705
Name:JOHNSON, CLARA AMANDA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:AMANDA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5212 BLAYLOCK RD
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38572-3271
Mailing Address - Country:US
Mailing Address - Phone:931-267-5952
Mailing Address - Fax:
Practice Address - Street 1:1045 HORSEHEAD LN
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37367-7432
Practice Address - Country:US
Practice Address - Phone:423-881-6358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31595363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health