Provider Demographics
NPI:1922404698
Name:JOHNSON, SHYRETHA (APRN, BC PMHNP)
Entity type:Individual
Prefix:
First Name:SHYRETHA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN, BC PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 NUUANU AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-5190
Mailing Address - Country:US
Mailing Address - Phone:808-777-9460
Mailing Address - Fax:808-217-9174
Practice Address - Street 1:928 NUUANU AVE STE 1
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5190
Practice Address - Country:US
Practice Address - Phone:808-777-9460
Practice Address - Fax:808-217-9174
Is Sole Proprietor?:No
Enumeration Date:2014-11-07
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1088061363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIAPRN-51690OtherSTATE OF HAWAII