Provider Demographics
NPI:1043013477
Name:ARDOIN, JOHANNA POOL (FNP-BC)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:POOL
Last Name:ARDOIN
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1149 MISSION CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-8611
Mailing Address - Country:US
Mailing Address - Phone:903-241-1514
Mailing Address - Fax:
Practice Address - Street 1:1149 MISSION CREEK DR
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-8611
Practice Address - Country:US
Practice Address - Phone:903-241-1514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1126558363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily