Provider Demographics
NPI:1053839548
Name:JOHNSON, FLORISTENE (RDN, LD)
Entity Type:Individual
Prefix:MS
First Name:FLORISTENE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:MRS
Other - First Name:FLORISTENE
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:1353 ARMSTRONG DRIVE
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115
Mailing Address - Country:US
Mailing Address - Phone:214-288-3287
Mailing Address - Fax:972-274-3970
Practice Address - Street 1:1353 ARMSTRONG DRIVE
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115
Practice Address - Country:US
Practice Address - Phone:214-288-3287
Practice Address - Fax:972-274-3970
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-05
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
357018133N00000X, 133V00000X
TX02575133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist