Provider Demographics
NPI:1932109311
Name:JOHNSON, SHAKIRA A (PA-C)
Entity Type:Individual
Prefix:
First Name:SHAKIRA
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA-C
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 1:2801 LEMMON AVE STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-2201
Practice Address - Country:US
Practice Address - Phone:214-266-1600
Practice Address - Fax:214-266-1790
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03607363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N7735OtherBLUE CROSS BLUE SHIELD
TX179551003Medicaid
TX179551001Medicaid
TX179551002Medicaid
TXQ28477Medicare UPIN
8C8662Medicare PIN