Provider Demographics
NPI:1508531328
Name:JOHNSON, SONYA
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SONYA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SONYA RANDOLPH
Mailing Address - Street 1:707 S CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:CROCKETT
Mailing Address - State:TX
Mailing Address - Zip Code:75835-2509
Mailing Address - Country:US
Mailing Address - Phone:936-349-5676
Mailing Address - Fax:
Practice Address - Street 1:707 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:CROCKETT
Practice Address - State:TX
Practice Address - Zip Code:75835-2509
Practice Address - Country:US
Practice Address - Phone:936-349-5676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA0008621891376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide