Provider Demographics
NPI:1982321790
Name:JOHNSON, DREAMA NICHOLE HALL (FNP-C)
Entity type:Individual
Prefix:
First Name:DREAMA
Middle Name:NICHOLE HALL
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 1:613 EVENING SHADE DR S
Mailing Address - Street 2:
Mailing Address - City:WHITE BLUFF
Mailing Address - State:TN
Mailing Address - Zip Code:37187-4083
Mailing Address - Country:US
Mailing Address - Phone:615-920-9411
Mailing Address - Fax:
Practice Address - Street 1:4335 HWY 70 E
Practice Address - Street 2:
Practice Address - City:WHITE BLUFF
Practice Address - State:TN
Practice Address - Zip Code:37187-9234
Practice Address - Country:US
Practice Address - Phone:615-797-1418
Practice Address - Fax:615-797-1421
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32833363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily