Individual
MS. PAULETTE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
2100 N 7TH ST, WEST MEMPHIS, AR 72301-2017
(870) 394-7804
(870) 394-7734
Mailing address
965 RIDGE LAKE BLVD STE 315, MEMPHIS, TN 38120-9401
(901) 227-7015
(901) 227-8591
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
227301
AR
363LF0000X
Family Nurse Practitioner
25872
TN
363LF0000X
Family Nurse Practitioner
901840
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08527334
—
MS
01
—
888508
MEDICARE MS
MS
05
—
Q051318
—
TN
01
—
T10930A
MEDICARE TN
TN
Enumeration date
11/14/2016
Last updated
03/28/2024
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