Molly L Johnson, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

0024170209 Issued in VA

Practice address

210 Pepsi Way
Wytheville, VA 24382-3030

Phone

(276) 625-2354

Fax

(276) 625-2357

NPI assigned

Jul 21, 2012

Last updated

Apr 28, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1342828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430179200000",
    "number": "1962757369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 PEPSI WAY",
            "city": "WYTHEVILLE",
            "state": "VA",
            "postal_code": "243823030",
            "telephone_number": "276-625-2354",
            "fax_number": "276-625-2357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 PEPSI WAY",
            "city": "WYTHEVILLE",
            "state": "VA",
            "postal_code": "243823030",
            "telephone_number": "276-625-2354",
            "fax_number": "276-625-2357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MOLLY",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-21",
        "last_updated": "2015-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024170209",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "P01130767",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "261083931",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1962757369",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Denise James, LCSW
• Anna Jarvis, BCABA
• Gordon W Jennings, OD PC
• Jerry R Willis DC (Willis Chiropractic)
• Tonya Renee Johnson-Clark, COTA
• Teddy R Johnson, DPM
• Darren B Jones, B.S.
• Matthew A Jones, NP-C
• Feliciano J Jusay, M.D.
• Linda Kay Justice

• Family Nurse Practitioner in Wytheville, VA
• Providers in Wytheville, VA by specialty
• Family Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.