Provider Demographics
NPI:1902553647
Name:JOHNSON, JOHN BENJAMIN (MSN, FNP-C)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:BENJAMIN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 BROAD ST STE 1
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2662
Mailing Address - Country:US
Mailing Address - Phone:919-220-9800
Mailing Address - Fax:919-220-9500
Practice Address - Street 1:2400 BROAD ST STE 1
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2662
Practice Address - Country:US
Practice Address - Phone:919-220-9800
Practice Address - Fax:919-220-9500
Is Sole Proprietor?:No
Enumeration Date:2022-03-02
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5015837363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily