Provider Demographics
NPI:1073183885
Name:JOHNSON, TAMARA LYNN
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:LYNN
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:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43115-0159
Mailing Address - Country:US
Mailing Address - Phone:740-993-2601
Mailing Address - Fax:
Practice Address - Street 1:10881 4TH ST
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:OH
Practice Address - Zip Code:43115-7509
Practice Address - Country:US
Practice Address - Phone:740-993-2601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRL7439223747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant