Provider Demographics
NPI:1366282444
Name:JOHNSTON, NIKKI LANELLE (FNP)
Entity type:Individual
Prefix:MS
First Name:NIKKI
Middle Name:LANELLE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4025 LAMAR AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75462-5244
Mailing Address - Country:US
Mailing Address - Phone:903-785-4600
Mailing Address - Fax:903-782-9150
Practice Address - Street 1:4025 LAMAR AVE STE 120
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75462-5244
Practice Address - Country:US
Practice Address - Phone:903-785-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1164390207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine