Provider Demographics
NPI:1730242306
Name:JOHNSON, BARBARA S (PMHNP)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:S
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 RIVER OAKS DR STE 140
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6845
Mailing Address - Country:US
Mailing Address - Phone:817-778-8884
Mailing Address - Fax:817-385-6540
Practice Address - Street 1:120 RIVER OAKS DR STE 140
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6845
Practice Address - Country:US
Practice Address - Phone:817-778-8884
Practice Address - Fax:817-385-6540
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX423882363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U87ZOtherBCBSTX GRP PIN
TX124218OtherSUPERIOR PIN
TX214256401Medicaid
1750369203OtherGRP NPI NUMBER
TX89N478OtherBCBSTX IND PIN
TX9079983OtherPHCS PIN
TX214256401Medicaid