Provider Demographics
NPI:1245881812
Name:JOHNSON, CAROL JEAN (FNP-C)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:JEAN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials: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:PO BOX 738801
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-8801
Mailing Address - Country:US
Mailing Address - Phone:765-289-7444
Mailing Address - Fax:765-289-8538
Practice Address - Street 1:1000 N 16TH ST STE 210
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-4319
Practice Address - Country:US
Practice Address - Phone:765-599-3800
Practice Address - Fax:765-521-7355
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71009405A363LF0000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily