Provider Demographics
NPI:1538365267
Name:JOHNSON, MISTY NOWELL (CCC-A, AUD)
Entity type:Individual
Prefix:DR
First Name:MISTY
Middle Name:NOWELL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CCC-A, AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1994 GALLATIN PIKE N STE 200
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-2024
Mailing Address - Country:US
Mailing Address - Phone:615-851-9005
Mailing Address - Fax:615-851-9007
Practice Address - Street 1:1994 GALLATIN PIKE N STE 200
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-2024
Practice Address - Country:US
Practice Address - Phone:615-851-9005
Practice Address - Fax:615-851-9007
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNA1706237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter