Provider Demographics
NPI:1689484974
Name:JOHNSON, HEATHER KAY (FNP-BC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:KAY
Last Name:JOHNSON
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2923 GINNALA DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-2702
Mailing Address - Country:US
Mailing Address - Phone:970-810-4676
Mailing Address - Fax:
Practice Address - Street 1:2923 GINNALA DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-2702
Practice Address - Country:US
Practice Address - Phone:970-810-4676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-09
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1000437363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily