Provider Demographics
NPI:1528206471
Name:JOHNSON, REBEKAH (MHPP)
Entity Type:Individual
Prefix:MS
First Name:REBEKAH
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:FORDYCE
Mailing Address - State:AR
Mailing Address - Zip Code:71742-3014
Mailing Address - Country:US
Mailing Address - Phone:870-352-5122
Mailing Address - Fax:870-352-5127
Practice Address - Street 1:1101 W 3RD ST
Practice Address - Street 2:
Practice Address - City:FORDYCE
Practice Address - State:AR
Practice Address - Zip Code:71742-3014
Practice Address - Country:US
Practice Address - Phone:870-352-5122
Practice Address - Fax:870-352-5127
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator