Provider Demographics
NPI:1003350828
Name:JOHNSON, FELICIA DAWN
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:DAWN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13735 LAKEWOOD MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-2796
Mailing Address - Country:US
Mailing Address - Phone:832-788-3631
Mailing Address - Fax:
Practice Address - Street 1:13735 LAKEWOOD MEADOW DR
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-2796
Practice Address - Country:US
Practice Address - Phone:832-788-3631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator