Provider Demographics
NPI:1538189618
Name:JOHNSON, MARY JANE (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:MARY JANE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 RUDD ROAD
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:TN
Mailing Address - Zip Code:37882
Mailing Address - Country:US
Mailing Address - Phone:865-448-6924
Mailing Address - Fax:
Practice Address - Street 1:2300 N WRIGHT RD
Practice Address - Street 2:
Practice Address - City:ALCOA
Practice Address - State:TN
Practice Address - Zip Code:37701-3141
Practice Address - Country:US
Practice Address - Phone:865-977-3302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000005147363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNAPN0000005147OtherTN BOARD OF NURSING