Provider Demographics
NPI:1639921265
Name:JOHNSON, ARLYN (IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:ARLYN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:MRS
Other - First Name:ARLYN
Other - Middle Name:
Other - Last Name:GRADNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5818 KYLE COVE DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-6434
Mailing Address - Country:US
Mailing Address - Phone:254-383-2326
Mailing Address - Fax:
Practice Address - Street 1:5818 KYLE COVE DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-6434
Practice Address - Country:US
Practice Address - Phone:254-383-2326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-306968174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN