Provider Demographics
NPI:1508068602
Name:JOHNSON, JULIANNE B (RD, LD)
Entity type:Individual
Prefix:
First Name:JULIANNE
Middle Name:B
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:JULIANNE
Other - Middle Name:
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:3506 GILA TRL
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-5022
Mailing Address - Country:US
Mailing Address - Phone:254-771-0775
Mailing Address - Fax:
Practice Address - Street 1:602 S STATE HIGHWAY 6
Practice Address - Street 2:CKD SERVICES OF MARLIN
Practice Address - City:MARLIN
Practice Address - State:TX
Practice Address - Zip Code:76661-3527
Practice Address - Country:US
Practice Address - Phone:254-883-3699
Practice Address - Fax:254-883-3055
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT01184133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal