Provider Demographics
NPI:1598790917
Name:JOHNSON, KATHY (P A)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:P A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6124 W PARKER RD STE 330
Mailing Address - Street 2:SUITE 330
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8125
Mailing Address - Country:US
Mailing Address - Phone:972-378-3272
Mailing Address - Fax:972-378-9853
Practice Address - Street 1:6124 W PARKER RD STE 330
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8125
Practice Address - Country:US
Practice Address - Phone:972-378-3272
Practice Address - Fax:972-378-9853
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00696363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP53218Medicare UPIN
TX87N228Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER