Provider Demographics
NPI:1801067608
Name:JOHNSON, HOLLY LYNNETTE (MPAS, PA-C)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:LYNNETTE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 FEDERAL ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4769
Mailing Address - Country:US
Mailing Address - Phone:877-660-6777
Mailing Address - Fax:412-359-8055
Practice Address - Street 1:1307 FEDERAL ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4769
Practice Address - Country:US
Practice Address - Phone:877-660-6777
Practice Address - Fax:412-359-8055
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02473363A00000X
NMPA2020-0099363A00000X
OKPA 2030363A00000X
PAMA057426363AS0400X
OH50.002757363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200348620AMedicaid
OK200348620AMedicaid