Individual
TIESHA D JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
1676 SUNSET AVE, UTICA, NY 13502-5416
(315) 624-4801
(315) 624-5401
Mailing address
111 HOSPITAL DR, ATTN: CREDENTIALING DEPT, UTICA, NY 13502
(315) 801-8534
(315) 801-8391
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
401131
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
APRN.CNP.024042
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0384373
—
OH
Enumeration date
08/06/2008
Last updated
12/11/2025
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