Provider Demographics
NPI:1417208091
Name:LAW JOHNSON, RYAN NICOLE (DNP, FNP)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:NICOLE
Last Name:LAW JOHNSON
Suffix:
Gender:
Credentials:DNP, FNP
Other - Prefix:DR
Other - First Name:RYAN
Other - Middle Name:NICOLE
Other - Last Name:LAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:89 OLD TROLLEY RD STE 207B
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-4953
Mailing Address - Country:US
Mailing Address - Phone:843-509-4257
Mailing Address - Fax:843-897-7951
Practice Address - Street 1:9330 MEDICAL PLAZA DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9104
Practice Address - Country:US
Practice Address - Phone:843-847-3225
Practice Address - Fax:843-897-7951
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17944363LF0000X, 363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP01264537OtherRAIL ROAD MEDICARE
SCNP2143Medicaid
SCSC02055277Medicare PIN