Provider Demographics
NPI:1871614834
Name:JOHNSON, PATRICIA K (FNP)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:K
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2009 COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-3460
Mailing Address - Country:US
Mailing Address - Phone:719-384-8181
Mailing Address - Fax:719-384-4872
Practice Address - Street 1:2201 SAN JUAN AVE
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-3323
Practice Address - Country:US
Practice Address - Phone:719-384-8181
Practice Address - Fax:719-384-4872
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO71174363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner