Provider Demographics
NPI:1073787024
Name:JOHNSON, JENNIFER LEIGH (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEIGH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
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 7663
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79608-7663
Mailing Address - Country:US
Mailing Address - Phone:325-242-1646
Mailing Address - Fax:
Practice Address - Street 1:4351 RIDGEMONT DR
Practice Address - Street 2:SUITE A
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-8701
Practice Address - Country:US
Practice Address - Phone:325-698-4545
Practice Address - Fax:325-698-4547
Is Sole Proprietor?:No
Enumeration Date:2008-04-21
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9573208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics