1669741526 NPI number — TARA BETH JOHNSON MS, RD, LD

Table of content: TARA BETH JOHNSON MS, RD, LD (NPI 1669741526)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669741526 NPI number — TARA BETH JOHNSON MS, RD, LD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
TARA
Provider Middle Name:
BETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, RD, LD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669741526
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4301 WILSON STREET
Provider Second Line Business Mailing Address:
REYNOLDS ARMY COMMUNITY HOSPITAL
Provider Business Mailing Address City Name:
FT SILL
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
75303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-558-2825
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4301 WILSON STREET
Provider Second Line Business Practice Location Address:
REYNOLDS ARMY COMMUNITY HOSPITAL
Provider Business Practice Location Address City Name:
FT SILL
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
75303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-558-2825
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/22/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  1878 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 243345 . This is a "ACADEMY OF LACTATION POLICY AND PRACTICE" identifier . This identifiers is of the category "OTHER".




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