Individual
NATHAN PATRICK JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC
Contact information
Practice address
4035 12TH ST CUTOFF SE STE 120, SALEM, OR 97302
(971) 304-9306
(503) 926-6624
Mailing address
PO BOX 12926, SALEM, OR 97309-0926
(971) 304-9306
(503) 926-6624
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
209338
TN
163WP0808X
Psychiatric/Mental Health Registered Nurse
201701389RN
OR
2084P0800X
Psychiatry Physician
201701390NPPP
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
0000022011
TN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
201701390NP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1952754442
PECO, NPPES
OR
Enumeration date
07/19/2016
Last updated
06/09/2025
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