Doctor Name: | DESIRRAY JOHNSON |
NPI Number: | 1346696200 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 43702 Hwy Business 290 Waller, TX - 77484 |
Business Phone Number: | 8323680792 |
Business Fax Number: | |
Mailing Address: | P.o. Box 2266, PRAIRIE VIEW |
State: | TX |
Postal Code: | 77446 |
Phone Number: | 8323680792 |
Fax Number: | |
NPI Enumeration Date: | 05/10/2016 |
NPI Last Update Date: | 05/10/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |