Provider Demographics
NPI:1619149440
Name:JOHNSON, FRANCINE F (RD)
Entity Type:Individual
Prefix:
First Name:FRANCINE
Middle Name:F
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1198
Mailing Address - Street 2:DEPT 03-007RC
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39181-1198
Mailing Address - Country:US
Mailing Address - Phone:601-883-4250
Mailing Address - Fax:601-883-4309
Practice Address - Street 1:104 MCAULEY DR
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39183-2825
Practice Address - Country:US
Practice Address - Phone:601-619-3610
Practice Address - Fax:601-631-2698
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0545133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS512I710020Medicare PIN