Provider Demographics
NPI:1821595950
Name:JOHNSON, SUMMER LYNN (FNP)
Entity type:Individual
Prefix:MRS
First Name:SUMMER
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SUMMER
Other - Middle Name:LYNN
Other - Last Name:FAVREAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FAVREAU FNP
Mailing Address - Street 1:590 MEDICAL CRT
Mailing Address - Street 2:
Mailing Address - City:FOT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544
Mailing Address - Country:US
Mailing Address - Phone:254-553-6366
Mailing Address - Fax:
Practice Address - Street 1:590 MEDICAL CRT
Practice Address - Street 2:
Practice Address - City:FOT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-553-6366
Practice Address - Fax:254-618-1014
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137243208VP0000X, 207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily