Provider Demographics
NPI:1790841468
Name:JOHNSON, JUANITA F (WHCNP)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:F
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:WHCNP
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 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4201 BROOK SPRING DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-4968
Practice Address - Country:US
Practice Address - Phone:214-266-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX691773363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196034610Medicaid
TX196034602Medicaid
TX196034604Medicaid
TX8Y5364OtherBLUE CROSS BLUE SHIELD
TX196034605Medicaid
TX196034601Medicaid
TX196034607Medicaid
TX196034608Medicaid
TX196034603Medicaid
TX196034606Medicaid
TX196034609Medicaid