Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 1011652 | TX |
NPI | 1003413808 |
---|---|
Provider Name | John Johnson |
First Address | Sherman, TX 75092-2662 |
Second Address | Sherman, TX 75092-2662 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2020 |
Last Update Date | 05/10/2020 |