Provider Demographics
NPI:1588736938
Name:JOHNSON, DEVONNA ANNE (FNP-C)
Entity type:Individual
Prefix:
First Name:DEVONNA
Middle Name:ANNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 781
Mailing Address - Street 2:
Mailing Address - City:PIE TOWN
Mailing Address - State:NM
Mailing Address - Zip Code:87827-0781
Mailing Address - Country:US
Mailing Address - Phone:204-881-7565
Mailing Address - Fax:888-614-3881
Practice Address - Street 1:926 MAIN ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37206-3614
Practice Address - Country:US
Practice Address - Phone:844-660-1069
Practice Address - Fax:615-235-9725
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR45687363L00000X, 363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ221096Medicaid
NM621766956OtherTIN