| Nathan Johnson, Pmhnp | |
|
4035 12th St Cutoff Se Ste 120 Salem OR 97302-1754 | |
| (971) 304-9306 | |
| (503) 926-6624 |
| Full Name | Nathan Johnson, Pmhnp |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 4035 12th St Cutoff Se Ste 120, Salem, Oregon |
| Authorized Official Name and Position | Nathan Patrick Johnson (OWNER) |
| Authorized Official Contact | 9713049306 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nathan Johnson, Pmhnp Po Box 12926 Salem OR 97309-0926 Ph: () - | Nathan Johnson, Pmhnp 4035 12th St Cutoff Se Ste 120 Salem OR 97302-1754 Ph: (971) 304-9306 |
| NPI Number | 1427527886 |
|---|---|
| Provider Enumeration Date | 11/15/2018 |
| Last Update Date | 04/13/2021 |
| Certification Date | 04/13/2021 |
| Medicare PECOS PAC ID | 2466780671 |
|---|---|
| Medicare Enrollment ID | O20190827000842 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427527886 | NPI | - | NPPES |
| 1952754442 | Other | TN | NPI |
| 500735377 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Primary |
| Provider Name | Nathan Patrick Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952754442 PECOS PAC ID: 3072882208 Enrollment ID: I20170703001391 |
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