Provider Demographics
NPI:1396090239
Name:JOHNSON-ROY, TAMERA LEE (RN, CNS)
Entity type:Individual
Prefix:MS
First Name:TAMERA
Middle Name:LEE
Last Name:JOHNSON-ROY
Suffix:
Gender:F
Credentials:RN, CNS
Other - Prefix:MS
Other - First Name:TAMERA
Other - Middle Name:LEE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CNS
Mailing Address - Street 1:2780 AIRPORT DR STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-2289
Mailing Address - Country:US
Mailing Address - Phone:614-859-1906
Mailing Address - Fax:614-645-5517
Practice Address - Street 1:1905 PARSONS AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-1933
Practice Address - Country:US
Practice Address - Phone:614-586-4159
Practice Address - Fax:614-586-4252
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704136194363L00000X, 364SG0600X
OH04494-NS364SM0705X, 364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical