Provider Demographics
NPI:1639893332
Name:JOHNSON, MEGHAN (FMP-C)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FMP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TDDC WOODLANDS
Mailing Address - Street 2:26103 INTERSTATE 45 STE 100
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380
Mailing Address - Country:US
Mailing Address - Phone:281-764-9531
Mailing Address - Fax:281-764-9501
Practice Address - Street 1:TDDC WOODLANDS
Practice Address - Street 2:26103 INTERSTATE 45 STE 100
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380
Practice Address - Country:US
Practice Address - Phone:281-764-9531
Practice Address - Fax:281-764-9501
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1090201363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily