Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | AP11331 | AZ |
NPI | 1205328382 |
---|---|
Provider Name | Darren Keith Johnson |
First Address | Kingman, AZ 86401-6224 |
Second Address | Kingman, AZ 86401-6224 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2018 |
Last Update Date | 04/06/2018 |