Provider Demographics
NPI:1174338669
Name:JOHNSON, SALLY S (ARNP)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:S
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5261 CARROLLTON PIKE STE A
Mailing Address - Street 2:
Mailing Address - City:WOODLAWN
Mailing Address - State:VA
Mailing Address - Zip Code:24381-3034
Mailing Address - Country:US
Mailing Address - Phone:276-730-5919
Mailing Address - Fax:
Practice Address - Street 1:9106 W RUTTER PKWY
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-9210
Practice Address - Country:US
Practice Address - Phone:276-730-5919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61638533363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily