Individual
NICKLETT R JOHNSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
688 W 4TH ST STE B, BENSON, AZ 85602
(520) 720-6551
(520) 720-6552
Mailing address
688 W 4TH ST STE B, BENSON, AZ 85602-6315
(520) 720-6551
(520) 720-6552
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
546098
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
184626301
—
TX
05
—
184626302
—
TX
05
—
184626303
—
TX
Enumeration date
02/15/2007
Last updated
08/23/2018
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