Provider Demographics
NPI:1922317775
Name:JOHNSON, JOHNNIE DARRYL (CNA)
Entity Type:Individual
Prefix:MR
First Name:JOHNNIE
Middle Name:DARRYL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 W BALTIMORE ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72936-4544
Mailing Address - Country:US
Mailing Address - Phone:479-597-8434
Mailing Address - Fax:
Practice Address - Street 1:811 W BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:AR
Practice Address - Zip Code:72936-4544
Practice Address - Country:US
Practice Address - Phone:479-597-8434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR050283161209E376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide