Doctor Name: | MICHELLE MCQUEEN JOHNSON |
NPI Number: | 1922381466 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | R865765 |
Business Practice Address: | 975 Hall St Wiggins, MS - 395772107 |
Business Phone Number: | 6015289119 |
Business Fax Number: | 6015289193 |
Mailing Address: | Po Box 419, WIGGINS |
State: | MS |
Postal Code: | 395770419 |
Phone Number: | 6015289119 |
Fax Number: | 6015289193 |
NPI Enumeration Date: | 09/21/2011 |
NPI Last Update Date: | 12/09/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R865765 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |