Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | P6258 | TX |
NPI | 1003130881 |
---|---|
Provider Name | Dr. Katherine Anna Johnson |
First Address | Southlake, TX 76092-2704 |
Second Address | Dallas, TX 75390 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2010 |
Last Update Date | 21/08/2018 |