Provider Demographics
NPI:1629019153
Name:JOHNSON, PRYNCESS (DPM)
Entity Type:Individual
Prefix:DR
First Name:PRYNCESS
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4036 LAZY STREAM CT
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-6933
Mailing Address - Country:US
Mailing Address - Phone:804-310-8392
Mailing Address - Fax:
Practice Address - Street 1:1201 BROAD ROCK BLVD PODIATRY DEPT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23249-1554
Practice Address - Country:US
Practice Address - Phone:804-675-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1924213ES0103X
VA0103300936213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAV05330Medicare UPIN
TXTXB100602Medicare PIN
TXTXB108877Medicare PIN