Provider Demographics
NPI:1548485048
Name:JOHNSON, MICHAEL ANTHONY (RN, ACNP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:RN, ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 WAVERLY CIR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79602-6858
Mailing Address - Country:US
Mailing Address - Phone:325-690-1805
Mailing Address - Fax:325-690-6145
Practice Address - Street 1:6200 REGIONAL PLZ
Practice Address - Street 2:SUITE 1200
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5250
Practice Address - Country:US
Practice Address - Phone:325-690-1805
Practice Address - Fax:325-690-6145
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX533709363L00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX533709OtherRN LIC STATE OF TEXAS