1689867145 NPI number — JODY L JOHNSON NP

Table of content: JODY L JOHNSON NP (NPI 1689867145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689867145 NPI number — JODY L JOHNSON NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
JODY
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
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:
1689867145
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 SPRING RIDGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURPHY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75094-4267
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-636-1198
Provider Business Mailing Address Fax Number:
972-384-0694

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 SPRING RIDGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURPHY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75094-4267
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-636-1198
Provider Business Practice Location Address Fax Number:
972-384-0694
Provider Enumeration Date:
08/19/2007

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: 363LG0600X , with the licence number:  531800 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1710172093 . This is a "GROUP NPI NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00Y958 . This is a "GROUP PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com