Provider Demographics
NPI:1447219076
Name:JOHNSON, CATHY JEAN (RN, APRN)
Entity type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:JEAN
Last Name:JOHNSON
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Gender:F
Credentials:RN, APRN
Other - Prefix:
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Mailing Address - Street 1:1867 AIRPORT WAY
Mailing Address - Street 2:SUITE 215
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4062
Mailing Address - Country:US
Mailing Address - Phone:907-456-1434
Mailing Address - Fax:907-456-1481
Practice Address - Street 1:1867 AIRPORT WAY
Practice Address - Street 2:SUITE 215
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4062
Practice Address - Country:US
Practice Address - Phone:907-456-1434
Practice Address - Fax:907-456-1481
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK761363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health