| Doctor Name: | LATASHA JOHNSON |
| NPI Number: | 1326463639 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | 51405 |
| Business Practice Address: | 310 W Losey St Bldg 1530 Scott Afb, IL - 622255250 |
| Business Phone Number: | 6182567804 |
| Business Fax Number: | |
| Mailing Address: | 202 Shoreline Dr, Apt # 4 O FALLON |
| State: | IL |
| Postal Code: | 622693035 |
| Phone Number: | 3344772658 |
| Fax Number: | |
| NPI Enumeration Date: | 02/24/2014 |
| NPI Last Update Date: | 02/24/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 51405 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |