Provider Demographics
NPI:1124375266
Name:JOHNSON, MARKEITA DANIELLE (NP)
Entity Type:Individual
Prefix:
First Name:MARKEITA
Middle Name:DANIELLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARKEITA
Other - Middle Name:DANIELLE
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:294 UPTOWN BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-3536
Mailing Address - Country:US
Mailing Address - Phone:972-293-3569
Mailing Address - Fax:972-299-9513
Practice Address - Street 1:294 UPTOWN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-3536
Practice Address - Country:US
Practice Address - Phone:972-293-3569
Practice Address - Fax:972-299-9513
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP122249363LF0000X
TX757283363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily