Provider Demographics
NPI:1669611224
Name:JOHNSON, ANN DRULANE (PA-C)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:DRULANE
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 1:720 PLEASANTON RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78214-1306
Mailing Address - Country:US
Mailing Address - Phone:210-921-3800
Mailing Address - Fax:210-334-2861
Practice Address - Street 1:7616 CULEBRA RD
Practice Address - Street 2:STE. 130
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-1476
Practice Address - Country:US
Practice Address - Phone:210-509-2603
Practice Address - Fax:210-334-2861
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00904363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202044803Medicaid
TX265370YKQQMedicare PIN
TX379158YKNCMedicare PIN