Provider Demographics
NPI:1245377944
Name:JOHNS, VICKI MILLER (RD,LD,CDE)
Entity type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:MILLER
Last Name:JOHNS
Suffix:
Gender:F
Credentials:RD,LD,CDE
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 314
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:TX
Mailing Address - Zip Code:75451-0314
Mailing Address - Country:US
Mailing Address - Phone:903-856-0039
Mailing Address - Fax:
Practice Address - Street 1:719 W COKE RD
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:TX
Practice Address - Zip Code:75494-3011
Practice Address - Country:US
Practice Address - Phone:903-342-3981
Practice Address - Fax:903-342-4181
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT02595133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered