Individual
MRS. MOLLY L JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
210 PEPSI WAY, WYTHEVILLE, VA 24382-3030
(276) 625-2354
(276) 625-2357
Mailing address
210 PEPSI WAY, WYTHEVILLE, VA 24382-3030
(276) 625-2354
(276) 625-2357
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024170209
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1962757369
—
VA
01
—
261083931
TAX ID
—
01
—
P01130767
PTAN
VA
Enumeration date
07/21/2012
Last updated
04/28/2015
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