Basic Information
| Provider Information | |||||||||
| NPI: | 1801212675 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON THOMAS | ||||||||
| FirstName: | JODI | ||||||||
| MiddleName: | RECHETTA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | AGPCNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 508 FULTON ST # 112 | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277053875 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192860411 | ||||||||
| FaxNumber: | 9194165857 | ||||||||
| Practice Location | |||||||||
| Address1: | 508 FULTON STREET #112 | ||||||||
| Address2: | |||||||||
| City: | DUNHAN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192860411 | ||||||||
| FaxNumber: | 9194165857 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2014 | ||||||||
| LastUpdateDate: | 04/27/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 5006753 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.