Provider Demographics
NPI:1760201255
Name:NP JOHNSON TELEHEALTH WELLNESS CARE, LLC
Entity type:Organization
Organization Name:NP JOHNSON TELEHEALTH WELLNESS CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DAMARIS
Authorized Official - Middle Name:LAVERNE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:314-520-8856
Mailing Address - Street 1:315 SPRING DAY CT
Mailing Address - Street 2:
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-1963
Mailing Address - Country:US
Mailing Address - Phone:314-520-8856
Mailing Address - Fax:
Practice Address - Street 1:315 SPRING DAY CT
Practice Address - Street 2:
Practice Address - City:LAKE SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-6336
Practice Address - Country:US
Practice Address - Phone:314-520-8856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty