Provider Demographics
NPI:1245894526
Name:JOHNSON, KAREN MICHELLE
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:MICHELLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:M
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSFN, RDN, LD
Mailing Address - Street 1:330 WHITE ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MS
Mailing Address - Zip Code:39073-9649
Mailing Address - Country:US
Mailing Address - Phone:601-559-4343
Mailing Address - Fax:
Practice Address - Street 1:330 WHITE ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MS
Practice Address - Zip Code:39073-9649
Practice Address - Country:US
Practice Address - Phone:601-559-4343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered