Provider Demographics
NPI:1922404698
Name:JOHNSON, SHYRETHA (APRN, BC PMHNP)
Entity type:Individual
Prefix:
First Name:SHYRETHA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN, BC PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5424 W HIGHWAY 290
Mailing Address - Street 2:SUITE 108
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735
Mailing Address - Country:US
Mailing Address - Phone:512-200-4380
Mailing Address - Fax:512-677-6806
Practice Address - Street 1:5424 W HIGHWAY 290
Practice Address - Street 2:SUITE 108
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735
Practice Address - Country:US
Practice Address - Phone:512-200-4380
Practice Address - Fax:512-677-6806
Is Sole Proprietor?:No
Enumeration Date:2014-11-07
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1088061363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health