Johnson, Nicole A

Johnson, Nicole A is an sole proprietor health care provider with primary practice located at 405 W Jackson St , Carbondale IL 62901-1462. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Medical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is her primary health care specialty. Johnson, Nicole A can be contacted via phone (618) 549-0721.

Contact Information

Primary practice address
405 W Jackson St Carbondale IL 62901-1462
Phone: (618) 549-0721
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 036-087287 Illinois
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 085-002903 Illinois

Profile Details

NPI number 1033250576
LBN Legal business name Johnson, Nicole A
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 9th, 2007
Last updated Nov 9th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1033250576 NPPES
Illinois Other 085-002903 PA LICENSE NUMBER

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