Johnson, Stacy L

Johnson, Stacy L is an individual health care provider with primary practice located at 2510 E Dupont Rd Ste 226 , Fort Wayne IN 46825-1603. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Johnson, Stacy L can be contacted via phone (260) 460-3100.

Contact Information

Primary practice address
2510 E Dupont Rd Ste 226 Fort Wayne IN 46825-1603
Phone: (260) 460-3100
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 28140959A Indiana
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 71002173A Indiana

Profile Details

NPI number 1417907189
LBN Legal business name Johnson, Stacy L
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date May 11th, 2006
Last updated Nov 20th, 2023 - about last year

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 1417907189 NPPES
Indiana MEDICAID 200846660

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