Nadra Johnson
Individual provider Active NPI Licensed Vocational Nurse · Watauga, TX
NPI 1194139089 · NPPES record last updated Jun 18, 2014
Key facts
- NPI
- 1194139089
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Vocational Nurse 164X00000X
- License
- 203234 (TX)
- Practice address
- 6601 Watauga Rd Ste 122
Watauga, TX 76148-3368 - Phone
- (817) 514-5030
- NPI assigned
- Jun 18, 2014
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 203234 | TX | MD | Licensed Vocational Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Vocational Nurse | 164X00000X | 203234 | TX | Yes |
Addresses
Primary practice location
6601 Watauga Rd Ste 122
Watauga, TX 76148-3368
Mailing address
6601 Watauga Rd Ste 122
Watauga, TX 76148-3368
Phone (817) 514-5030
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All providers in Watauga, TX · Licensed Vocational Nurse in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 18, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.