Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP125305 | TX |
NPI | 1003221441 |
---|---|
Provider Name | Quyen Johnson |
First Address | Denison, TX 75020-4587 |
Second Address | Denison, TX 75020-1249 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2014 |
Last Update Date | 15/06/2020 |