Provider Demographics
NPI:1578269775
Name:JOHNSON, ANGELE KENNEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANGELE
Middle Name:KENNEY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 WOODLANDS GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-7108
Mailing Address - Country:US
Mailing Address - Phone:336-991-6052
Mailing Address - Fax:
Practice Address - Street 1:173 WOODLANDS GLEN CIR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047-7108
Practice Address - Country:US
Practice Address - Phone:336-991-6052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator