Provider Demographics
NPI:1588346902
Name:JOHNSON, ADRIAN TAKEYAMA (APRN-CNP)
Entity type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:TAKEYAMA
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 HITCHING POST CT
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79911-2246
Mailing Address - Country:US
Mailing Address - Phone:415-847-4956
Mailing Address - Fax:
Practice Address - Street 1:7505 HITCHING POST CT
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79911-2246
Practice Address - Country:US
Practice Address - Phone:415-847-4956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-04
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1129628363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner