Individual
NICHOLAS SAMUEL JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
2223 TECHNOLOGY DR, O FALLON, MO 63368-7272
(636) 561-5999
Mailing address
2223 TECHNOLOGY DR, O FALLON, MO 63368-7272
(636) 561-5999
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2019006383
MO
Other
Enumeration date
08/21/2025
Last updated
08/21/2025
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