Provider Demographics
NPI:1710761168
Name:JOHNSON, DESTINEE DEANNA
Entity Type:Individual
Prefix:
First Name:DESTINEE
Middle Name:DEANNA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6653 MCKINNEY RANCH PKWY APT 5104
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-2216
Mailing Address - Country:US
Mailing Address - Phone:214-842-0546
Mailing Address - Fax:
Practice Address - Street 1:6653 MCKINNEY RANCH PKWY APT 5104
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-2216
Practice Address - Country:US
Practice Address - Phone:214-842-0546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer