Provider Demographics
NPI:1114059516
Name:JOHNSON, VALERIE (PA)
Entity Type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6450 FOLSOM DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-7269
Mailing Address - Country:US
Mailing Address - Phone:409-835-0524
Mailing Address - Fax:409-923-1293
Practice Address - Street 1:6450 FOLSOM DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-7269
Practice Address - Country:US
Practice Address - Phone:409-835-0524
Practice Address - Fax:409-923-1293
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02197363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant