| Doctor Name: | MRS. ANNIE JOHNSON |
| NPI Number: | 1003067984 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | PA-777 |
| Business Practice Address: | 708 E Wythe Creek Ct Ste 103 Kuna, ID - 836345005 |
| Business Phone Number: | 2089225130 |
| Business Fax Number: | 2089225132 |
| Mailing Address: | Po Box 68, KUNA |
| State: | ID |
| Postal Code: | 836340068 |
| Phone Number: | 2089225130 |
| Fax Number: | 2089225132 |
| NPI Enumeration Date: | 10/09/2008 |
| NPI Last Update Date: | 12/01/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA-777 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |