Provider Demographics
NPI:1932483252
Name:JOHNSON, CYNTHIA ANN (FNP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 PARKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-5535
Mailing Address - Country:US
Mailing Address - Phone:704-470-7092
Mailing Address - Fax:949-864-3002
Practice Address - Street 1:111 N HOFFMAN ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:NC
Practice Address - Zip Code:28034-1597
Practice Address - Country:US
Practice Address - Phone:704-470-7092
Practice Address - Fax:949-864-3002
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2025-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005395363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP3419OtherMEDICARE PTAN
NC1932483252Medicaid
NCNC4006COtherMEDICARE PTAN
SCSCP3714292Medicaid
NC1932483252Medicaid
NCNCA400EMedicare PIN
NCNCA400HMedicare PIN
NCNCA400DMedicare PIN
NCNCA400CMedicare PIN