Provider Demographics
NPI:1992499024
Name:JOHNSON, ROBERT LEE III (FNP-C)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LEE
Last Name:JOHNSON
Suffix:III
Gender:M
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 1:955 STONEGATE DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-2607
Mailing Address - Country:US
Mailing Address - Phone:540-815-4101
Mailing Address - Fax:
Practice Address - Street 1:1802 ELECTRIC RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-1619
Practice Address - Country:US
Practice Address - Phone:540-283-3760
Practice Address - Fax:540-989-2869
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-02
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAF05231239363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily