Organization
STASIS PSYCHIATRY, LLC
Active
Other names
Nathan Johnson, PMHNP
Organization subpart
No
Provider details
NPI number
Authorized official
NATHAN PATRICK JOHNSON MSN (OWNER)
(971) 304-9306
Entity
Organization
Contact information
Practice address
4035 12TH ST CUTOFF SE STE 120, SALEM, OR 97302-1754
(971) 304-9306
(503) 926-6624
Mailing address
PO BOX 12926, SALEM, OR 97309-0926
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1952754442
NPI
TN
05
—
500735377
—
TN
Enumeration date
11/15/2018
Last updated
04/13/2021
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